Board of Long-Term Care Administrators
Forms & Applications
The below documents are in Microsoft Word format. If you do not have Microsoft Word, you can get the Microsoft® Word Viewer to view and print DHP's documents.
Nursing Home Administrator Forms:
General Information
Application for Licensure by Endorsement
Application for Initial Licensure
- Nursing Home Administrator Application for Initial Licensure
- NAB NHA Test Attestation Form (Required prior to sitting for exam)
Application for Administrator-In-Training
- Domains of Practice
- Core of Knowledge
- Application for Administrator-in-Training (For a list of licensed Preceptors who volunteered their contact information be posted in a public directory, please click on the following link: Preceptor Directory)
- Monthly Report for AIT
- Documentation of Completion Form
- Notice for Change of Status or Discontinuance in AIT Program
Application for Registration/Reinstatement as a Preceptor
Application for Reinstatement
National Association of Boards of Examiners of Long-Term Care Administrators (NAB)
- Click here to visit NAB's website to download a PDF or MSWord copy of their Candidate Handbook and register to take NAB.
Continuing Competency
Assisted Living Facility Administrator Forms:
ALF-AIT Education and Experience Matrix
ALA Application for Licensure by Education
- Checklist for Licensure by Education to Practice As An Assisted Living Facility Administrator
- Assisted Living Facility Administrator Application for Licensure
- NAB RCAL Test Attestation Form (Required prior to sitting for exam)
ALA Application for Licensure by Endorsement or Credentials
- Checklist for Licensure by Endorsement or Credentials to Practice As An Assisted Living Facility Administrator
- Assisted Living Facility Administrator Application for Licensure
- Endorsement Certification Form
ALA Application for Reinstatement
ALA Application for Administrator-in-Training
- Assisted Living Facility Administrator-in-Training Application (For a list of licensed Preceptors who volunteered their contact information be posted in a public directory, please click on the following link: Preceptor Directory)
- Monthly Report of Assisted Living Facility Administrator-In-Training
- Completion of Assisted Living Facility Administrator-In-Training
- Domains of Practice
- Notice of Change of Status or Discontinuance for Assisted Living Facility Administrator-In-Training
ALA Application for an “Acting” Administrator-in-Training
ALA Application for Certification/Reinstatement as a ALA Preceptor
Continuing Competency