Failed Clinical Skills Examinations Question Title * 1. Candidate First Name: Question Title * 2. Candidate Last Name: Question Title * 3. Last 4 digits of Candidates SSN: Question Title * 4. Please Select Your Test Site from the List Below: ATC39 CKTC01 CTC04 CTC05 CTTC06 CVTC02 CVTC03 CVTC53 EOTC07 FTTC08 GCTC09 GPTC10 GPTC11 GRCTC62 HPTC12 ICTC13 ICTC14 ICTC15 ICTC79 KTC17 KTC18 KTC19 KTC20 KTC21 KTC22 KTC23 KTC57 KTC78 MATC31 MDTC32 MNTC33 MTC16 MTTC84 NETC34 NETC35 NETC36 NETC52 NWTC37 NWTC38 PTCA41 PTCPC40 RRTC42 SOTC43 SWTC44 TCTC45 TTC46 WTC51 WTC68 WWTC50 Question Title * 5. Which Clinical Skills Exam did the candidate take? 2A Developmentally Disabled Direct Care Aide - 8602 5A Home Health Care Aide - 8605 7C Long-Term Care Aide - 8607 Question Title * 6. Date of Failed Clinical Exam (MM/DD/YYYY): Date Date Question Title * 7. Enter the CSO number (i.e. 199012345): Question Title * 8. Enter the Training Facility Code: Done
