Form Doh 667-034 - Nursing Assistant Expired Certification Activation Application

ADVERTISEMENT

Nursing Assistant Expired Certification Activation
Application Packet
Contents:
1. 667-032 ......Contents List/SSN Information/Mailing Information .....................1 page
2. 667-033 ......Application Instructions Checklist ............................................... 2 pages
3. 667-034 ......Nursing Assistant Expired Certification Activation Application.... 3 pages
4. RCW/WAC Links and Online Websites Links ..................................................1 page
Important Social Security Number Information:
You are required by state and federal law to provide a social security number with your
application. If you do not have a social security number at the time you send in this
application, contact the Customer Service Center at 360-236-4700 for more information.
A U.S. Individual Taxpayer Identification Number (ITIN) or a Canadian Social Insurance
Number (SIN) cannot be substituted.
In order to process your request:
Mail your application with initial
documentation and your check
Send other documents not sent
or money order payable to:
with initial application to:
Department of Health
Nursing Assistant Credentialing
PO Box 1099
PO Box 47877
Olympia, WA 98507-1099
Olympia, WA 98504-7877
Contact us:
360-236-4700
DOH 667-032 September 2016

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 9