Get Utah Nursing Assistant Registry

The Utah Nursing Assistant Registry provides a streamlined process for individuals seeking to update their information regarding name or address changes. This guide will walk you through each step involved in completing the online application form.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the application form and open it in your preferred editor.
2. Indicate the type of change you are requesting by checking the appropriate box. You can request a name change, an address change, or both.
3. In the NAME field, provide your name exactly as it appears on your CNA Certificate. In the BIRTHDATE field, enter your birthdate in the format MM/DD/YYYY.
4. For a name change request, fill out the NAME CHANGE REQUESTED field with the new name you wish to have.
5. Enter your SOCIAL SECURITY NUMBER, ensuring accuracy to avoid processing delays.
6. Provide your PHONE NUMBER for any necessary follow-ups.
7. Insert your NEW MAILING ADDRESS, including the apartment number if applicable. Include the CITY, STATE, and ZIP CODE for precise delivery.
8. Include your E-MAIL ADDRESS for electronic communication regarding your application.
9. Fill in your UTAH CNA CERTIFICATE NUMBER and the ISSUE DATE of your certificate.
10. If you are requesting a name change, ensure you include one of the required documents to verify your name change. Remember to only include copies, not original documents.
11. Certify the accuracy of your information by signing the form and including today’s date.
12. Once you have completed the form, save any changes, and you can proceed to download, print, or share your application as needed.

Take the first step towards updating your information and complete the Utah Nursing Assistant Registry application online today.