How to Become a CNA in North Carolina

To become a CNA in North Carolina, you must complete a minimum of 75 hours of state-approved Nurse Aide I training, then pass a competency examination administered by Credentia through its CNA365 platform. After passing, your name is added to the NC Nurse Aide Registry within 2 to 5 business days, and you’re eligible to begin employment.

Unlike some states where nursing boards oversee CNA certification, North Carolina assigns this responsibility to the Division of Health Service Regulation (DHSR), specifically the Health Care Personnel Education and Credentialing Section. This distinction matters because contacting the wrong agency wastes time. Reach NC DHSR at 919-855-3969 or [email protected].

What	Details
Governing Body	NC Division of Health Service Regulation (DHSR), not the Board of Nursing
Training Required	75 hours minimum (16 hours practical, 16 hours classroom before patient contact)
Testing Vendor	Credentia via CNA365 platform
Initial Exam Fee	$140 (combined written/oral + skills)
Registry Enrollment	2 to 5 business days after passing both exam portions
Renewal Cycle	Every 24 months (8 hours paid work required, no continuing education hours)

North Carolina operates a two-tier nursing assistant system: Nurse Aide I is the foundational certification this guide covers, and Nurse Aide II is an optional advanced credential with expanded scope. Every CNA must complete Nurse Aide I first.

Eligibility Requirements for NC CNA Training

Age Requirements and Career and College Promise

NC DHSR does not mandate a specific minimum age in state regulation, but carries a long-standing recommendation of 16.5 years as the minimum for training enrollment. This is more nuanced than what most sources state.

High school juniors and seniors can pursue CNA I certification through Career and College Promise programs, which allow dual enrollment in community college CNA courses. These programs follow the same state-approved curriculum and lead to the same Nurse Aide I certification as adult programs.

One important planning consideration: maintaining your registry listing requires 8 hours of paid nursing assistant work within each 24-month renewal cycle. Many healthcare employers require workers to be 18 or older. If you certify at 16 or 17, you may struggle to meet this work requirement until you reach hiring age.

The financial and timing pressure this creates is real:

“I won’t be eligible for CNA training until I turn 18 in September 2026, which is after I start at UNC Charlotte (if I go there). I’m from a low-income family, so I’m trying to waste as little time and money as possible.”

(3 upvotes – Reddit user)

If you’re in a similar situation, contact NC community colleges offering CNA programs through Career and College Promise to explore whether you qualify to start earlier than you expect.

Education Prerequisites

NC DHSR has no state-level education mandate for Nurse Aide I. Individual training programs set their own requirements. Some accept students who pass an 8th-grade reading competency test; others require a diploma or GED. Contact your chosen program to confirm their specific prerequisites.

Background Check and Health Screening

NC DHSR requires background check screening through the Health Care Personnel Registry. Disqualifying findings include substantiated abuse, neglect, or misappropriation. Past criminal history does not automatically disqualify you since each case is reviewed individually.

Clinical training sites typically require a TB test, physical exam, and current immunizations. Your training program coordinates these requirements and tells you what to obtain before your first clinical day.

North Carolina CNA Training Program Requirements

State-Mandated 75 Training Hours

North Carolina requires a minimum of 75 hours of state-approved training before you can sit for the competency examination. That breaks down as at least 16 hours of combined lab and clinical training, and at least 16 hours of classroom instruction covering Modules A through G before any patient contact. Programs typically complete the full 75 hours in 3 to 4 weeks on a full-time schedule, or 6 to 8 weeks part-time.

The pre-clinical requirement exists for patient safety: you must cover fundamentals like infection control, safety, communication, and patient rights before entering a real healthcare setting.

Curriculum Overview

NC uses the State-Approved Nurse Aide I Curriculum (July 2024 version) covering basic nursing skills, restorative services, personal care, infection control, safety and emergency procedures, communication, and patient rights. Instructors must hold an unencumbered NC RN license with a minimum of 2 years (4,000 hours) of nursing experience plus documented teaching or supervising experience.

Program Costs by Type

Program Type	Typical Cost
Community college	$800 to $1,200
Private vocational school	$1,000 to $1,500
Online hybrid (in-person skills lab required)	$200 to $600
Facility-sponsored (with work commitment of 6 to 12 months)	$0

Multiple financial aid pathways can reduce or eliminate these costs. See the NC CNA Exam Costs and Financial Aid section for details on NC Propel, WIOA, and scholarship programs.

Finding State-Approved Programs

Ready to find a state-approved program near you? Our comprehensive North Carolina CNA Programs Guide provides searchable listings of community colleges, vocational schools, and facility-sponsored programs across the state, including program details, costs, schedules, and contact information.

The NC CNA Competency Examination Through Credentia

North Carolina administers the CNA competency examination through Credentia, not Pearson VUE as some outdated sources indicate. Credentia uses the CNA365 platform for test registration, scheduling, and online proctoring. Attempting to register through Pearson VUE leads to dead ends. The correct portal is credentia.com/test-takers/ncna.

The examination has two mandatory portions: a knowledge assessment (written OR oral, your choice) plus a hands-on skills demonstration. You must pass both to achieve certification.

Exam Component Comparison

Component	Format	Questions/Skills	Time	Modality
Written exam	Multiple choice	70 total (60 scored, 10 pretest)	2 hours	In-person OR online proctored
Oral exam	Verbal	60 knowledge + 10 word recognition	2 hours	In-person OR online proctored
Skills exam	Hands-on demonstration	5 skills (Hand Hygiene + 4 random)	30 minutes	In-person ONLY

Written Exam Details

The 70 questions include 60 scored and 10 unscored pretest questions used for future exam development. You won’t know which 10 are unscored, so treat all 70 as equally important. Content covers patient care, basic nursing skills, restorative services, patient rights, safety and emergency procedures, and infection control.

NC DHSR does not publicly disclose the numeric passing score. You receive a Pass or Fail notification only.

Oral Exam Option

If reading comprehension is a challenge, or if a verbal format works better for you, the oral exam offers 60 knowledge questions delivered verbally plus 10 word recognition questions. It’s available in English and Spanish, and can be taken in person or online proctored.

Skills Exam Structure

Hand Hygiene is always tested; four additional skills are randomly selected from the NC state checklist. Each skill includes Critical Element Steps: actions essential to patient safety. Missing any single Critical Element Step results in automatic failure for that skill, even if you perform all other steps correctly.

Your training program prepares you for every skill on the state checklist. You can’t predict which 4 additional skills you’ll draw, but you don’t need to.

For comprehensive exam preparation strategies, explore our CNA exam preparation resources.

Preparing for the NC CNA Skills Exam

Every NC candidate demonstrates Hand Hygiene because it’s the guaranteed skill. Four additional skills are randomly selected from the state checklist. Categories include personal care (bathing, feeding, toileting), vital signs, mobility assistance (transfers, ambulation), and range of motion exercises.

Each skill’s Critical Element Steps represent the actions that cannot be skipped or performed incorrectly. Missing even one means automatic failure for that skill. The 30-minute window for all 5 skills requires confident, methodical work.

The anxiety around NC-specific skills testing is common:

“Any tips would be amazing!!! Especially in the in North Carolina?”

(Reddit user)

For detailed skills demonstrations, practice checklists, and exam preparation strategies specific to NC, explore our Complete CNA Skills Test Guide with step-by-step walkthroughs of all skills on the NC checklist.

Scheduling Your Exam Through Credentia CNA365

Once you complete state-approved training, you’ll register for the examination through Credentia’s CNA365 platform.

Step 1: Create Your CNA365 Account

Visit credentia.com/test-takers/ncna and create an account using your legal name (must match your government-issued ID exactly), contact information, and Social Security Number. Account activation takes 24 to 48 hours.

Step 2: Obtain Your Test Voucher

Most training programs include a voucher covering your initial exam attempt ($140 value). Your program coordinator provides the voucher code to enter during registration. If your program doesn’t include one, or if you’re retaking the exam, pay directly through CNA365 by credit or debit card.

Step 3: Choose Your Testing Modality

For the written or oral exam, you can test in person or choose online proctored from home. Online proctoring requires a reliable internet connection, a computer with webcam and microphone, and a private quiet room. The skills exam is in-person only with no remote option regardless of circumstances.

Step 4: Select Your Location and Schedule

Credentia operates test centers across North Carolina. When scheduling through CNA365, available locations nearest your ZIP code appear automatically. Major testing regions include the Triangle (Raleigh, Durham, Cary), Charlotte Metro, the Triad (Greensboro, Winston-Salem, High Point), Asheville, Wilmington, and Fayetteville.

Exam appointments are typically available within 1 to 4 weeks. Plan ahead if you complete training between May and August, when demand is highest.

NC CNA Exam Costs and Financial Aid

Understanding the full financial picture before enrolling helps you plan, and knowing your aid options may change what that picture looks like.

Exam Fee Breakdown

Exam Component	Initial Fee	Retake Fee
Combined (written/oral + skills)	$140	N/A
Written or oral only (retake)	N/A	$40
Skills only (retake)	N/A	$100
Rescheduling fee	$15 to $25	$15 to $25

If you pass one portion but need to retake the other, you pay only for the failed component.

NC Financial Aid Programs

Program	Coverage	How to Apply
NC Propel	Tuition-free CNA training	Register with NCWorks Career Center at nccareers.org
WIOA Funding	Tuition, books, fees, childcare, transportation, uniforms, and certification fees	Contact local NCWorks Career Center for eligibility assessment
Next NC Scholarship	Full tuition and fees at NC community colleges	Through NC community college financial aid office; household income below $80,000/year
Golden LEAF Scholarship	Tuition, fees, books, credentialing tests, transportation, and childcare	Through participating community college; rural or economically distressed NC counties

Many NC CNAs complete training at little to no personal cost through these programs. Find your local NCWorks center at nccareers.org/find-location.

To stretch your preparation budget, use our free CNA practice tests to assess your readiness before scheduling.

What to Expect on NC CNA Exam Day

Your exam day runs more smoothly when you know exactly what’s required.

Required Documents

• Valid government-issued photo ID: driver’s license, state ID, passport, or military ID
• Confirmation email or appointment details (print or save to phone)
• Social Security card (some test centers require this; confirm when scheduling)

Your ID must match the name on your CNA365 registration exactly. If your name has changed, bring supporting documentation such as a marriage certificate or court order. Arriving without matching documentation may result in being turned away.

Arrival and Check-In

Plan to arrive 15 to 30 minutes before your appointment. Late arrival (more than 15 minutes after your scheduled time) typically results in denied entry and a forfeited exam fee, with rescheduling required.

At check-in, you’ll present your ID, sign for identity verification, review testing rules, and receive a locker for prohibited items before being escorted to the testing area.

What to Leave Home

Cell phones and all electronic devices, study materials, bags, food and drinks (for the testing room), and watches or jewelry must stay in your locker. Outerwear is also stored.

What to Wear

For the written or oral exam, wear comfortable clothing in layers since room temperatures vary. For the skills exam, wear clean scrubs or professional medical attire with closed-toe shoes and hair pulled back. Scrubs are a requirement for the skills portion, not just a suggestion.

Testing Environment

Written and oral exams take place in quiet rooms with individual computer stations or desks. The skills exam is conducted in a mock patient care setting with a hospital bed, medical equipment, and a mannequin or live model. Proctors monitor continuously and will not answer content questions.

NC Nurse Aide Registry Enrollment and Maintenance

The North Carolina Nurse Aide Registry is the official database of all certified CNAs in the state, maintained by NC DHSR. Your registry listing confirms your active certification status and allows healthcare employers to verify your credentials before hiring and during employment.

Registry Enrollment Timeline

After passing both the written or oral exam AND the skills exam, Credentia reports your results to NC DHSR electronically. Your name appears on the NC Nurse Aide Registry within 2 to 5 business days. Four things trigger enrollment: passing both exam portions, Credentia’s electronic report, background check clearance from training, and Social Security Number verification.

No separate registry application is required. The process is automatic after passing.

Verifying Your Active Registry Status

Official portal: ncnar.ncdhhs.gov/verify_listings1.jsp

To search:
1. Enter your last name and the last 4 digits of your Social Security Number
2. Select “Active” status filter
3. Submit search

Your listing shows your full legal name, registry number, certification date, expiration date, current status (Active, Expired, or Inactive), and any disciplinary actions on record. Employers use this same portal before hiring and periodically throughout your employment.

Understanding the 24-Month Renewal Cycle

NC uses a rolling 24-month renewal cycle, not a fixed calendar year. Your 24 months begins on your initial certification date and rolls forward with each renewal.

Example: Certified March 15, 2024 → Expires March 15, 2026 → Renew before expiration → New cycle: March 15, 2026 through March 15, 2028.

NC DHSR does not send renewal reminder notifications. Tracking your expiration date is entirely your responsibility. Set a phone calendar reminder at least 90 days before your expiration date.

Renewal Requirements

To renew your NC Nurse Aide I listing, you must meet two requirements.

Requirement 1: Employment Verification
A minimum of 8 hours of paid nursing assistant work under RN supervision within the 24-month period. Volunteer hours do not count. Private duty employment does not qualify unless the work was provided through a licensed home health agency. “Under RN supervision” means an RN was available on-site or reachable by phone.

Requirement 2: RN Supervisor Signature
The Registered Nurse who supervised your work completes an Employment Verification Form confirming their RN license number, contact information, and verification of your 8 or more hours. NC does NOT require in-service training hours for renewal, unlike many states requiring 12 to 48 continuing education hours. The 8-hour work requirement is the only maintenance standard.

Digital Renewal Submission Process

Since August 2021, NC DHSR accepts only digital renewal submissions. Paper forms are no longer processed.

To renew:
1. Complete the Online Renewal Form at ncnarforms.ncdhhs.gov within 90 days of your expiration date
2. Your supervising RN completes the Employment Verification Form digitally
3. Both forms go to DHSR electronically
4. DHSR reviews and updates your status, typically within 1 to 2 weeks
5. Verify your updated expiration date on the registry portal

There is no renewal fee for NC Nurse Aide I certification.

What Happens When Your Listing Expires

Career changes and life circumstances lead many CNAs to inadvertently let their listings lapse:

“I got my CNA officially in 2023 but ended up taking a lab job and really only used it for three months? Now I want to look into getting it again but it shows my listing expired Jan 2025. I’m in North Carolina and other than the regular renewal process I’m not sure if I have to retake the class because it’s been a couple months of it being expired??”

(Reddit user)

This scenario is more common than people expect. Once your 24-month period ends without renewal, your listing status changes to “Expired.” You cannot work as a CNA with an expired listing. Healthcare facilities verify active status before and during employment.

If your listing has already expired, NC requires you to retrain completely and retest. There is no abbreviated recovery process after expiration. You must re-enroll in a state-approved 75-hour program, complete training again, retake the Credentia competency examination, and re-establish your registry listing.

Proactive Option: Training Waiver Application

If you know before your expiration date that you won’t meet the 8-hour work requirement, NC DHSR offers a proactive alternative: the Training Waiver Application.

Submit the Training Waiver Application to DHSR at least 45 days before your expiration date. If approved, you retake only the competency examination (written/oral plus skills) instead of retraining. Passing reactivates your listing for a new 24-month cycle.

When this option applies:
– A career change temporarily moved you away from CNA work
– Family or medical leave prevented employment
– Relocation delayed finding a new CNA position
– You recently certified but haven’t secured your first job yet

To apply, contact NC DHSR at [email protected] or 919-855-3969 and request the Training Waiver Application. Submit it before expiration with a brief explanation. This option can save you 75 hours of retraining time and $800 to $1,500 in program costs. Once your status reads “Expired,” the Training Waiver is no longer available.

Maintaining Active Status: Best Practices

• Set a phone calendar reminder 90 days before expiration
• Keep copies of employment verification documentation
• Maintain contact with a former supervising RN in case you change careers
• Verify your registry status annually at ncnar.ncdhhs.gov/verify_listings1.jsp
• If approaching expiration without 8 hours on record, request the Training Waiver Application immediately

Retake Policies and Exam Attempts

Many successful CNAs needed more than one attempt before achieving certification. Understanding retake policies lets you approach the exam with a clear backup plan if needed.

Three-Attempt Limit Within 2 Years

North Carolina allows 3 total attempts to pass the competency examination within 2 years of completing training, whichever deadline arrives first.

Scenario	Outcome
Complete training January 2025; use 2 attempts by March 2025	1 attempt remains, valid until January 2027
Complete training January 2025; still have unused attempts in January 2027	2-year deadline expires; must retrain regardless
Exhaust all 3 attempts before 2-year deadline	Must retrain before attempting again

Partial Pass Provisions

If you pass one portion but fail the other, you only retake what you failed:

• Pass written/oral, fail skills: retake skills only ($100)
• Pass skills, fail written/oral: retake written/oral only ($40)

Your passing score remains valid through your entire 3-attempt and 2-year window. You don’t reset to zero.

Scheduling Retakes

Schedule retakes through the same CNA365 process. No mandatory waiting period between attempts, though additional study time before retaking is strongly recommended. Pay the retake fee during scheduling.

If you’re approaching your 2-year deadline or using your final attempt, contact NC DHSR to ask whether the Training Waiver Application might provide an alternative pathway.

Transferring Your CNA Certification to North Carolina (Reciprocity)

If you’re a certified CNA in another state moving to or working in North Carolina, you can transfer your certification through reciprocity (also called interstate endorsement). North Carolina is a reciprocity state under 10A NCAC 13O.0301, meaning out-of-state CNAs can obtain NC Nurse Aide I listing without repeating training.

NC’s Dual-Pathway Reciprocity System

Pathway	Who Can Use It	Processing Time
Standard Interstate Endorsement	CNAs from any U.S. state	Within 10 business days
Regional Agreement (new Oct 2025)	CNAs from GA, SC, TN, VA, or WV ONLY	2 to 4 weeks

Most applicants use Pathway 1. Pathway 2, created by NC Session Law 2025-61 effective October 1, 2025, provides an alternative for residents of eligible neighboring states who cannot meet Pathway 1’s work or exam requirement.

Pathway 1: Standard Interstate Endorsement (Recommended)

Eligibility requirements:
– Active certification on another state’s Nurse Aide Registry
– Good standing in all states where you’ve held certification (no disciplinary actions)
– No findings of abuse, neglect, or misappropriation
– Must meet ONE: at least 8 hours of paid nursing assistant work within the past 24 months, OR passed your state’s competency exam within the past 24 months

If your certification is active but you haven’t worked or tested in 24-plus months, you may need to retake NC’s competency exam (not full retraining) to demonstrate recent competency.

Required documentation:
1. Completed Reciprocity Application (download from ncnar.ncdhhs.gov)
2. Original signed Social Security card (copies not accepted)
3. Unexpired government-issued photo ID
4. Legal name documents if your current name differs from your certification

Submission: Email scanned documents to [email protected], or mail to NC DHSR, 2709 Mail Service Center, Raleigh, NC 27699-2709. No fee for Pathway 1.

Pathway 2: Regional Agreement (GA/SC/TN/VA/WV Only)

Effective October 1, 2025, NC created a regional reciprocity agreement with five neighboring states: Georgia CNA certification, South Carolina CNA certification, Tennessee CNA certification, Virginia CNA certification, and West Virginia CNA certification.

Additional requirements beyond Pathway 1:
– NC residency verification (utility bill, lease agreement, or similar)
– Federal background check through FBI (approximately $28 to $50)
– State background check through NC (approximately $20 to $30)
– Active certification in your home state for at least 1 year

Use Pathway 1 if you qualify, since it’s faster and costs nothing.

Lapsed Out-of-State Certifications

If your out-of-state certification has expired, NC does not allow reciprocity transfer. You must re-enroll in a state-approved 75-hour NC training program, complete training, pass the NC competency exam, and establish a new NC listing.

If you’re planning to move to NC and your certification is approaching expiration, renew in your home state before relocating to preserve your reciprocity eligibility.

Step-by-Step Reciprocity Application

1. Verify active status in your current state’s registry and print the verification page
2. Gather documents: Social Security card (original, signed), photo ID, legal name documents if needed
3. Download and complete the Reciprocity Application from ncnar.ncdhhs.gov
4. Email or mail the complete package to DHSR
5. Receive DHSR confirmation (10 business days for Pathway 1, 2 to 4 weeks for Pathway 2)
6. Verify your NC Nurse Aide I listing at ncnar.ncdhhs.gov/verify_listings1.jsp; your new 24-month cycle begins on transfer approval date

Next Steps: Beginning Your NC CNA Career

With your understanding of North Carolina’s certification process, you’re equipped to navigate each step from eligibility through active registry listing. Once your name appears on the NC Nurse Aide Registry, you can begin CNA employment immediately. Hospitals, nursing homes, assisted living facilities, and home health agencies across North Carolina actively seek qualified Nurse Aide Is.

Most working CNAs far exceed the 8-hour renewal minimum just by showing up for shifts. The real risk is forgetting to submit the digital renewal forms before your expiration date, since DHSR sends no reminder. Mark your calendar 90 days out and you’ve handled the hardest part of maintenance.

After gaining experience as a Nurse Aide I, you may choose to pursue CNA II certification through the NC Board of Nursing, which expands your scope to sterile dressing changes, wound irrigation, discontinuing IVs, and tube feedings. Learn more at ncbon.com when you’re ready.

For ongoing questions about your NC Nurse Aide I Registry listing:
– Phone: 919-855-3969 (Mon-Fri, 8am-12pm and 1pm-3pm)
– Email: [email protected]
– Registry portal: ncnar.ncdhhs.gov
– Address: NC DHSR, 2709 Mail Service Center, Raleigh, NC 27699-2709

Additional resources:
– North Carolina CNA Programs Guide for training program listings
– Complete CNA Skills Test Guide for skills exam preparation
– CNA exam preparation resources for study strategies