Forms

All the forms used by the Board can be found below or elsewhere on this site.

AIT/Preceptor Documents

• Administrator in Training AIT Requirements
• Administrator-In-Training (AIT) Approval
• AIT Approved Programs and Preceptors
• AIT Certification Program Completion
• Application for Preceptor
• Preceptor/Administrator-In-Training Agreement
• Administrator-In-Training Monthly Report
• AIT Certification Program Completion

Continuing Education (CEU) Program

• Continuing Education Accreditation Form – Individual
• Continuing Education Accreditation Form – Organization

License Renewal Forms

• Renewal Instructions
• Renewal Application
• Fee Schedule
• RFA Facilities Fact Sheet
• Change/Addition of Facility
• Personal Information Update

Nursing Facility Administrator (NFA) Forms

• NFA Application Instructions
• Initial Application or Reciprocity
• Fee Schedule
• AIT Program Approved AIT Programs & Preceptors
• Licensed Nursing Facility Administrator

Residential Facility Administrator (RFA) Forms

• RFA Application Instructions
• Initial Application
• Fee Schedule
• Licensed Residential Facility Administrators

Other Forms

• Facilities Fact Sheet
• Facilities Fact Sheet
• Change or Addition of Facility
• License Verification Form
• Notice of Termination - Return of License
• Credit Card Authorization Form