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Test Administration Services Entity (TASE) Application

**Important:** Please do not complete this application without prior consultation with our team.

TASE will: 
  • Hire, supervise, and compensate test administration teams (test team) that include at least one 
    • Registered Nurse Test Observer(s) (RN-TO) to administer the skills test portion of the exam 
    • Certified Actor(s) for the skills test portion of the exam
    • Certified Knowledge Test Proctor(s) (KTP) for on-site knowledge exam administration (not needed if using Remotely Proctored Knowledge Exam testing)
  • Ensure their certified test team(s) perform at least three test administrations per year. 
  • Ensure that regional seats are available at every scheduled test event
  • Provide timely, quality, unbiased test administration services that comply with State and Federal law. 
  • Provide all necessary electronic testing equipment that is compatible with COMPANY’s software. 
  • Provide all testing supplies required by the State to administer tests to State and Federal standards. 
  • Provide secure, reliable hotspots and/or Wi-Fi/internet access for their test team(s). 
  • Provide HEADMASTER proof of: 
    • Test team member’s state-required testing eligibility. 
    • Annual recertification of testing eligibility. 
    • TASE’s business entity formation status. 
    • TASE’s Workers’ Compensation insurance coverage per State regulations. 
    • General liability insurance is not required, but highly recommended for your business entity. 
  • The TASE understands and will comply with all State and Federal regulations, including but not limited to: 
    • State Approved Testing Standards (see Attachment A found at www.hdmaster.com, under the ‘Business Entities Providing Testing Services’ heading). 
    •  Americans with Disabilities Act (ADA). 
    • Recent criminal background checks for applicable testing team members if required per State requirements.
    • Agree to the Monitoring and Statistical Analysis of their RN Test Observer(s) (TOs) and other test team members. 
  • Correctly submit testing packet materials (printed and/or electronic) to COMPANY the same day tests are administered. 
  • Assume responsibility for the team’s State and Federal taxes and withholdings. 
  • Assume liability for failure to administer tests in compliance with this agreement and applicable regulations. 
Please fill out this application and attach the following documentation for your test team(s) RN Test Observer:
  • An updated resume detailing their one-year experience providing care for the elderly or chronically ill of any age 
  • A copy of their RN Nursing License 
Please fill out this application and attach the following documentation:
  • W-9 (with your business name and your Federal Tax ID number on it - remember to sign it; there has to be a wet signature.) Click here to open the W-9 form
  • Direct Deposit Form, must include a voided check or bank letter (to electronically process successfully completed testing payments from Headmaster to you).   Click here to open the Direct Deposit Form. 
    • Note: this does not have to be a business bank account; we can electronically deposit your testing payments into any bank account.
There is a one-time fee of $100.00 per TASE-provided RN Test Observer to certify that they have the necessary qualifications to administer exams that meet State testing standards. Please complete the credit/debit card certification fee payment information when you submit this application.

You will attest in the Affidavit at the end of this document that you have read, understand, and will abide by the following documents.  Please print these documents and keep them for your records.
ACTOR STATE TRAINING GUIDE STANDARDS
KNOWLEDGE TEST PROCTOR (KTP) STATE TRAINING GUIDE STANDARDS
TEST SITE EQUIPMENT LIST
TEST ADMINISTRATION SERVICES (TASE) AGREEMENT FORM 1505-OR

Once you have completed all of the fields and uploaded the required documents within this application, select “Send Application" to submit your application.
Address
RN License Information
TASE-PROVIDED RN TEST OBSERVER WORK EXPERIENCE VERIFICATION
TASE-PROVIDED RN TEST OBSERVER REFERENCE
TASE-PROVIDED RN TEST OBSERVER RESUME
TEST ADMINISTRATION SERVICES ENTITY (TASE)
IRS FORM W-9 Request for Taxpayer Information
DIRECT DEPOSIT FORM
Affidavit
CONFIDENTIALITY/NONDISCLOSURE:
We acknowledge that the nursing assistant competency examination is confidential. This includes the materials, processes, procedures, and content of the examination's knowledge and manual skills portions. 
  • We agree to safeguard the confidentiality of all information about the nursing assistant competency examination. 
  • We will not disclose any portion of the examination materials.
  •  We will not disclose the processes or procedures necessary to administer or pass the examination.
  •  We will not disclose any examination results to instructors or administrators of any training facility or program.
We understand that this agreement extends to and includes, but is not limited to, allowing unauthorized persons to hear, view, videotape, or otherwise gain any knowledge about the exam before, during, or after the administration of an exam.  We recognize that disclosing or revealing, or allowing this information to be disclosed or revealed, constitutes a violation of this agreement and could place our testing team RN Test Observers' nursing license at risk and/or be subject to prosecution to the full extent of the law and/or a $100,000 fine. I agree to immediately report any known or suspected breach in security relative to the nurse aide competency examination by calling the HEADMASTER home office at (800) 393-8664.

TESTING TEAM ACTOR AND KNOWLEDGE TEST PROCTOR (KTP) TRAINING AFFIDAVIT:
As a TASE, we swear that we have provided, reviewed, and will abide by the Actor training material and Knowledge Test Proctor training guidelines with any individual(s) we choose to use as an Actor or Knowledge Test Proctor.   
  • We attest that the individual(s) we choose to use as our Actor(s) and/or KTP(s) have completed the Actor and/or Knowledge Test Proctor (KTP) Training Affidavit and Confidentiality/Nondisclosure Agreement Applications available at https://or.tmutest.com/apply
  • We also understand that any Actor or Knowledge Test Proctor we choose to use will not be able to sit for the Nurse Aide test for twelve (12) months from the date that they were last used as an Actor or Knowledge Test Proctor.
TEST SITE EQUIPMENT LIST: (Keep a copy of this form for your records.)  
We hereby certify that we, along with our RN Test Observer, will check the test sites before each test event to ensure the test site equipment listed on the Test Site Equipment List Form is available and in good working order. If not, the RN Test Observer will report missing or inoperable test site equipment by listing it in TMU© under the test discrepancies before submitting the test event observations for scoring. 

TEST ADMINISTRATION SERVICES (TASE) AGREEMENT FORM 1505-OR:  (Keep a copy of this agreement for your records.)
We hereby certify that I have read, understand, and will abide by the terms and conditions of the Testing Administration Services Agreement Form 1505-OR as established to do business by statute in the State of Oregon.  
  • We understand that there is a one-time fee of $100.00 (per TASE-provided RN Test Observer) to certify that each TO has the necessary qualifications to administer exams that meet State testing standards. 
We have uploaded the required documentation with this application, which includes:
  • Our testing team RN Test Observer's Resume and a copy of their RN License
  • Signed (with a wet signature) W-9 Form with our business name and Federal Tax ID
  • Direct Deposit Form with a voided check or bank letter
By Submitting
I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.
Application Fee $100.00
Non-Refundable. All fees are non-refundable.
We accept Visa and Mastercard.
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1.800.393.8664