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STATE OF UTAH

DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING

APPLICATION FOR LICENSURE

MEDICATION AIDE-CERTIFIED

INSTITUTION/FACILITY/ASSOCIATION

APPLICATION INSTRUCTIONS AND INFORMATION:

General Statement:

The Utah Division of Occupational and Professional Licensing (DOPL) desires to provide courteous and

timely service to all applicants for licensure. To facilitate the application process, submit a complete application form including

all applicable supporting documents and fees. Failure to submit a complete application and supply all necessary information

will delay processing and may result in denial of licensure. The fees are for processing your application and will not be refunded.

Please read all instructions carefully.

Address of Record:

The address provided on this application will be your address of record. All correspondence from DOPL

will be sent to that address. You are responsible to directly notify DOPL of any change to your address of record. Do not rely on

a forwarding order as state mail is not forwarded.

APPLICATION INSTRUCTIONS:

Mandatory Attachment Checklist

(Applications with incomplete attachments will not be considered and may be denied.)



Submit a complete Division of Occupational Licensing (DOPL) application form to the DOPL address below.



Submit Appropriate Application Fees

Medication Aide-Certified – Institution/Facility/Association: $500.00 Non-Refundable Application Fee



The program consists of a minimum of 60 clock hours of didactic (classroom) training which is consistent with the model

curriculum in Section R156-31b-803, and at least 40 hours of practical training within a long-term care facility.

The classroom instructor shall:

have a current, active, unencumbered LPN, RN or APRN license or multistate privilege to practice nursing in Utah;



and have at least one year of clinical experience;

be an approved certified nurse aide (CNA) instructor who has completed a “Train the Trainer” program recognized by

the Utah Nursing Assistant Registry; and have at least one year of clinical experience.

The on-site practical training experience instructor shall meet the following criteria:

have a current, active, unencumbered LPN, RN or APRN license or multistate privilege to practice nursing in Utah;

and have at least one year of clinical experience;

be an approved certified nurse aide (CAN) instructor who has completed a “Train the Trainer” program recognized by



the Utah Nursing Assistance Registry; and have at least one year of clinical experience.

Please note: The practical training instructor-to-student ratio shall be: 1:2 if the instructor is working one-on-one with the

student to administer the medications; or 1:6 if the instructor is supervising a student who is working one-on-one with the

clinical facility's medication nurse. The on-site practical training experience instructor shall be on-site and available at all

times if the student is not being directly supervised by a licensed nurse during the practical training experience.



provide evidence of adequate and appropriate trainers and resources to provide the training program including a well-

stocked clinical skills lab or the equivalent

submit a copy of the proposed training curriculum and an attestation that the proposed curriculum is consistent with



the model curriculum in Section R156-31b-803

Document minimal admission requirements including, but not limited to: an earned high school diploma or successful

passage of the general educational development (GED) test; current certification as a nursing aide, in good standing, from

the Utah Nursing Assistant Registry, with at least 2,000 hours of experience within the two years prior to application to



the training program, working as a certified nurse aide in a long-term care setting; and current cardiopulmonary

resuscitation (CPR) certification.

DOPL-AP- Rev 2013-03-18

Application For Licensure - Medication Aide-Certified Institution/facility/association

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