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- Click ‘Get Form’ to open the cdph 283b form in the editor.
- Begin with Section I, where you must select the type of request. Check the appropriate box for CNA training, HHA training, equivalent training, or reciprocity from another state.
- Proceed to Section II. Fill in your personal details including Last Name, First Name, MI, Sex, Mailing Address, Date of Birth, and Social Security Number. Ensure all required fields are completed accurately.
- In Section III, answer the questions regarding any criminal convictions and health-related licensing actions. If applicable, provide details as requested.
- Complete Section IV if you have received or will receive CNA or HHA training. Include the name of the school and relevant dates.
- Finally, sign and date Section V to certify that your information is true and correct before submitting your application.
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