213 E Capitol Ave., Suite 101 Jefferson City, MO 65101

573-635-7226 fax 573-635-9848 573-635-7227 www.e-mcca.org

Medication Certification Test Bank User Agreement

This agreement is entered into by the Missouri Coalition of Children’s Agencies (MCCA) as test provider and ______________________________ Company/Agency Name) who will be utilizing the medication test bank of questions for the purpose of certification of child youth care workers in the administration of medications. Said company agrees to keep these test questions secure and confidential for use by instructors giving this examination. Test questions are not to be distributed or shared in any manner to include electronic transfer, etc. with anyone not directly involved in the testing of students at the above listed company. This user agreement must be signed prior to test questions being released by MCCA. ___________________________ Missouri Coalition of Children’s Agencies Company/Agency Name

___________________________ Mary Chant Name of Director or Administrator: Executive Director ______________________________________ ______________ Signature ______________________________________ Date

TM

Signature

Attachment 5