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MAP - 414 To Be used for New Program Requests and Reporting Existing Program Changes

This form is to be used by ALL nurse aide training programs EXCEPT those operated by KCTCS and for secondary students.

This form is not complete until you electronically sign, submit, and receive a thank you email. Partial/Incomplete entries will not be reviewed. If you are viewing this on an iPhone, iPad, Android, or other type smart-device, please view in landscape mode (turn your device sideways)

On June 6, 2022, the Cabinet for Health and Family Services and Department for Medicaid Services, following direction from CMS and the Governor's office, announced the expiration of Waivers related to nurse aide training. Since the State of Emergency is lifted, programs approved through the self-attestation process will be decertified on October 6, 2022. All new requests for training programs, which include programs under the temporary status, will be required to complete all paperwork according to MAP 414 instructions, prior to Covid waivers, including a site visit before approval of a new program will be granted. This form is not complete or submitted until you sign at the end of the form, hit submit, and receive an email confirmation of receipt. You will not be contacted if you partially complete this form. If you do not sign and click on submit, you will be required to start the form over.

If you experience difficulty or sign and submit but do not receive a confirmation email, please email with the subject MAP-414 Issue.
Thank you KNAT Services
1. Please answer the following questions
Type of Request *This question is required.
Type of Training Program *This question is required.
I affirm I have been an RN for more than two years. *This question is required.
This question requires a valid email address.