Cdph 279 form 2026

1. Click ‘Get Form’ to open the cdph 279 form in the editor.
2. Begin by entering your Facility/School/Agency Telephone Number and Provider Identification Training Number. Ensure these details are accurate for proper identification.
3. Fill in the County and Facility/School/Agency Name and Address. This information is crucial for processing your application.
4. Select the Type of Training to be Offered by checking the appropriate box: Orientation and In-Service Training Programs Only, Nurse Assistant Training Program (NATP) Only, or both.
5. Complete the Applicant’s Name section along with your California Nursing License Number and its Expiration Date.
6. Indicate the Facility Licensed Bed Capacity if applicable, and provide the Date Submitted to CDPH.
7. Sign as the Applicant, noting your Hours Employed per week and Date Employed as DSD / Instructor.
8. Attach required documents such as your resume, proof of DSD class completion, and a copy of your active nursing license using our platform's upload feature.

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