Maryland Department of Health
Board of Nursing

Individual and/or Facility Request for CNA Application

​If you are an Individual please provide the following: 
  1. Name of Individual
  2. Address
  3. Telephone number
  4. Type of application desired: Endorsement, Renewal, or Initial application
If you are an Agency please provide the following:
  1. Agency Name
  2. Address
  3. Name and title of contact person
  4. Telephone No
  5. Number of Endorsement applications needed
  6. Number of Initial CNA Applications needed 
Please fax your request to 410-764-8042, or send an e-mail to us, or send a letter to: Maryland Board of Nursing, Nursing Assistant Certification Program, 4140 Patterson Avenue, Baltimore, MD 21215.