Submit New Application

MA Reciprocity Form 9110 Application

NOTE: Please do not use this system for renewing your nurse aide certification in Massachusetts. 

For information regarding a renewal - click here

DO NOT COMPLETE THIS FORM if you have ever been listed on the Massachusetts Nurse Aide Registry. Contact the MA Registry at (617) 753-8144 or click here to verify your status. 

Please read these directions before you complete and submit this form. Your request for reciprocity cannot be processed if it is incomplete, illegible, or includes false statements. Candidates seeking out-of-state nurse aide registry placement must be in good standing on a nurse aide registry in a state that meets the Massachusetts requirements for reciprocity to be eligible for certification in Massachusetts.
 
[NOTE FOR INDIVIDUALS CERTIFIED IN MARYLAND: Individuals certified in Maryland maintain an active CNA license type - Geriatric Nursing Assistant in order to be eligible for reciprocity into Massachusetts.] 

Complete this form, 9110MA. Attach the required identification documents (see below). 

Your name will be placed on the registry if you are qualified after the following is successfully completed: 
  • We verify your certification (in good standing) with the state(s) where you are currently registered. 
  • The Massachusetts nurse aide registry verifies you are eligible for placement on the registry. 
  • All other provided and pertinent information is verified as true and correct. Notification of successful submission for MA registry placement will be emailed to the email address in your application. 
Your application is not complete until the required information is included, then select “Send Application.”
Address
Reciprocity Information
Required Questions
Affidavit
I agree that if all the requested documentation is not submitted with this application, and I do not reply to any of D&SDT-Headmaster's *emailed requests within one (1) month of submitting my application, my application will be denied and I will need to resubmit a new application.

*NOTE: If you have an iCloud email, you may not receive our communications and you may need to call to check your status.

By Submitting
I hereby verify that I understand and agree with the statements contained herein and the above information is true and correct.