RTC Feedback Form

First Name

Last Name

RTC Reference ID Number

Email Address

Phone Number

Date of Exam

Location of Exam

Exam Type

Manual Skills and Written Exam

Manual Skills Exam

Written Exam

Written (Audio-English) Exam

Nature of Grievance: Please select the area that best describes your grievance

Test Content: Issues with the clarity, fairness, or accuracy of exam questions

Testing Environment: Concerns related to the physical environment (noise, temperature, seating, etc.).

Testing Accommodations: Problems related to requested accommodations not being provided or insufficient support.

Technical Issues: Problems related to computerized testing, software, or malfunctioning equipment.

Administrative Issues: Concerns about scheduling, check-in procedures, or staff behavior.

Other

Other Grievance

Description of Grievance: Please provide a detailed description of the issue(s) you encountered during your CNA exam. Include any specific incidents or actions that led to your grievance:

Any Additional Comments

I acknowledge that my grievance will be reviewed by the appropriate parties and that I may be contacted for further information or clarification.

Yes, I understand and consent.