2.2 Education, Military, and Out-of-State Routes E2-E4

Three Reviewed Backgrounds

Not every candidate trains from scratch in Washington. Routes E2-E4 cover three backgrounds that WABON and DOH must review before testing:

• E2 - Nursing student or graduate: an individual who completed the comprehensive nursing-assistant portion of a state-approved RN or LPN nursing program. You submit an official school transcript, or an original letter on school letterhead confirming completion, to DOH.
• E3 - Military nursing assistant: an individual who completed a recognized military program. The handbook names the U.S. Army 91-C Program, the Navy's Basic Hospital Corps School, and the Air Force Apprentice (Specialist) Program. You submit documentation to DOH to determine qualification.
• E4 - Out-of-state graduate: an out-of-state nursing-assistant training graduate, or an out-of-state RN/LPN program graduate, whose training meets Washington's equivalency standard.

The operative word for all three is review. The background may support eligibility, but it does not bypass Washington's credentialing steps.

The Out-of-State Equivalency Standard

E4 candidates must show their training matches Washington's floor. The handbook's equivalency standard is precise: completion of the nursing-assistant portion of a curriculum, or at least fifty (50) hours of clinical training and thirty-five (35) hours of classroom training (108 hours combined). DOH reviews the transcript or letter and, if approved, emails you to complete Credentia registration.

Because E4 applicants trained elsewhere, they often lack a Washington program relationship for skills logistics. If you have no program to provide a skills test, WABON can help book one through an approved program - contact WABONNursingAssistantsED@doh.wa.gov.

Authorization to Test Is Mandatory for E2-E4

This is the rule that trips up confident, well-trained candidates: routes E2-E5 and E7-E9 require a complete DOH Credentialing application and an Authorization to Test (ATT) before you may register for the exam. Since E2, E3, and E4 all fall in that group, none of them may self-schedule on the strength of a transcript or military record alone.

Separate two questions in your planning:

1. Does my background satisfy Washington's requirement? (the equivalency/qualification question)
2. Have I completed the DOH application and received my ATT? (the permission question)

You can answer "yes" to the first and still be blocked on the second. You will not be able to test without an Authorization to Test, and at the skills site you must bring the ATT letter as proof of eligibility. Keep copies of every record so the route you select on the application matches the evidence you submit - a mismatch forces a resubmission and another wait. Treat the ATT as the green light, not your prior credential.

Common E2-E4 Traps and How DOH Reviews

The reviewed routes share a predictable set of traps that cost candidates weeks:

• Assuming experience equals permission. A military medic, an RN student, or an aide certified in another state may genuinely know the material - but Washington still controls the credentialing process, the exam sequence, and the testing authorization. Prior experience answers only the qualification question.
• Submitting incomplete documentation. DOH cannot approve an E2 transcript that omits the comprehensive nursing-assistant portion, or an E4 letter that fails to show the 50 clinical + 35 classroom hours. After you apply, DOH typically emails you a list of what is still missing - use that email as a checklist rather than guessing.
• Selecting the wrong route on the application. Choosing E1 when you are really E4, for example, can route your file incorrectly and trigger a resubmission. Match the route label to the evidence.
• Booking a skills test before the ATT arrives. Without the ATT letter in hand, the skills site can turn you away, and it is not obligated to refund the fee.

For military E3 candidates specifically, only certain programs qualify by name: the Army 91-C Program, the Navy Basic Hospital Corps School, and the Air Force Apprentice (Specialist) Program. Other military medical training may still be reviewed, but DOH makes the qualification decision from the documentation you submit; you cannot self-certify equivalency.

Once the route is approved, E2-E4 candidates rejoin the same exam path as everyone else: skills first, then the 70-question written or oral knowledge test on Credentia, four attempts per part before retraining. The difference is entirely front-loaded. If you handle the application and ATT correctly at the start, the testing phase is identical to an E1 candidate's - so the reviewed routes reward patience with paperwork far more than extra studying.

One more practical point for E2-E4 candidates without a Washington program: skills logistics. Because you did not train at a Washington school, you may have no program to proctor your skills test. In that case WABON helps book a skills exam through an approved program - email WABONNursingAssistantsED@doh.wa.gov - or you use a regional test site listed on the Credentia website. Either way you still complete the five-skill, 30-minute evaluation, and you must bring your ATT letter. Plan this early, because regional skills dates fill up and a missed date means re-registering and re-paying.