NATP Program Providers

Complete ENTIRE SECTION for demographic and contact changes such as program name, address (physical or mailing), facility contact, program closure, etc. Provide the currently approved information, as well as the changes that will be implemented.  Note the required fields, even if no changes are requested.

Complete ENTIRE SECTION for changes such as policy updates, textbook, program hours, instruction days/times, etc. Note that the instruction days and times must equal the reported program hours. Additional instructions and examples are also available in the Nurse Aide Application Packet Instructions, available here.

1. Program hours -- Provide the instruction hours for each of the following: Total (do not include orientation); Classroom/theory; Lab/skills; Orientation to clinical site(s); Clinical.
2. Instruction Days/Times -- Complete all fields.  If change requested, use the PROPOSED (new) schedule.  If no change is beinng requested, use the CURRENT (approved) schedule.
   • DAYS: Days that instruction will be conducted (ex: Monday thru Friday)
   • TOTAL # DAYS: Total number of instruction days for classroom/lab and clinical 
   • TIMES: Time that instruction will be conducted each day; include total time for breaks (ex: 8:00 AM to 12:00 PM, 30 minute break)
   • TOTAL INSTRUCTION TIME:  Total instruction time in hours; do not include breaks.
3. Instruction Days/Times of Additional Class(es) -- use if the program offers multiple or additional class times. Use the same format as above. 

Any changes to the textbook or class/lab hours requires submission of the corresponding LDH Curriculum, LDH Skills Performance Record, and revised policy.

Use to submit addition or removal of RN Coordinator(s) and/or Instructors.  

1. ALL current coordinators and instructors must be listed, as processing of this form will replace all previous personnel on file. 
2. An approval letter for these changes will NOT be generated.
3. A copy of this form as well as the documentation that the RN Coordinator or Instructor meets criteria must be maintained in your records. 
4. The RN Coordinator may not supervise more than two nurse aide training programs, and must be on site at least 50% of all classroom and clinical instruction time.
5. The RN Coordinator may serve as instructor, unless the RN Coordinator is the Director of Nursing (facility-based programs).
6. RN Coordinators must meet the following criteria: 
   • At least 2 years nursing experience as an RN;
   • At least 1 year of direct care in a long term care (NH) or SNF;
   • Have a current, unemcumbered RN license in the state of LA; and 
   • Have one (1) of the following: 
     1. Master’s degree or above;
     2. VTTIE;
     3. CTTIE; or
     4. Train the trainer certificate.
7. Instructors must meet the following criteria:
   • Have at least 2 years of nursing experience in caring for the elderly and/or chronically ill;
   • Have a current, unencumbered nursing license in the state of LA; and
   • Have one (1) of the following:
     1. Master’s degree or above;
     2. VTTIE;
     3. CTTIE; or
     4. Train the trainer certificate.

Complete this section for addition, removal, or updates to the clinical contracts of Clinical Training Sites.

1. Per CFR 483.151 (b), LAC 10011(E), and LAC 10015 (A), clinical training MUST be conducted at an eligible nursing home or SNF. See Directory of Nursing Homes for licensed facilities. 
   • The Clinical Site Status form contains enforcements that make a facility ineligible for training. Use of the form will prevent the need to contact the program desk to determine eligiblity. 
2. ALL current clinical training sites must be listed, as processing of this form will replace all sites on file. 
3. An approval letter for these changes will NOT be generated.
4. The program must have a clinical contract and Clinical Site Status Form for each clinical site to be used. 
5. A copy of the NATP Change Form, the clinical contract(s), and Clinical Site Status Form(s) must be maintained in your records. 
6. See the Nurse Aide Training New Program Approval Process for additional requirements/information. 

The "Statement of Acknowledgement and Attestation" on the Form must be signed and dated for changes to be considered. It is acceptable to use electronic or digital signature. 

NOTE:  To ensure proper functionality of the Change Form, please download the form to your desktop and then edit.  If form is completed in your browser, the form will not allow for signature or email.  Once completed, save with program name, Change Form, and date.   It can then be attached to email.

Electronically submit (DO NOT SCAN) the completed NATP Change Form and any additional information required for processing via email to HSS-CNA-DSW-Request@la.gov. 

It is strongly recommended to review the resources and templates in the Application Packet on the Nurse Aide Training New Program Approval Process website. Templates have been created for multiple documents, to ensure programs meet regulatory requirements, and the regulations pertaining to each are cited in the Policy template. Programs should begin the process of updating program information, as they will be necessary for approval of future changes.