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 97/2000 to view and print DHP's documents.
Nursing Home Administrator Forms:
General Information
Application for Licensure by Endorsement
- Nursing Home Administrator Application for Licensure by Endorsement - rev 10/01/2007
- Endorsement Verification Form - rev 03/28/2008
Application for Initial Licensure
Application for Administrator-In-Training
- Domains of Practice - rev 10/03/2007
- Core of Knowledge - rev 10/03/2007
- Application for Administrator-in-Training - rev 10/01/2007
- Monthly Report for AIT - rev 10/03/2007
- Documentation of Completion Form - rev 10/03/2007
- Notice for Change of Status or Discontinuance in AIT Program - rev 10/03/2007
Application for Registration/Reinstatement as a Preceptor
Application for Reinstatement
- Nursing Home Administrator Application for Reinstatement of License - rev 10/01/2007
- Endorsement Verification Form - rev 03/28/2008
National Association of Boards of Examiners of Long-Term Care Administrators (NAB)
- Click here to link to NAB's website to download a PDF or MSWord copy of their Candidate Handbook and register to take NAB.
Assisted Living Facility Administrator Forms:
ALA Application for Licensure by Experience
Assisted Living Facility
Administrator Application for Licensure
ALF-AIT Education and Experience Matrix
Assisted
Living Facility Administrators 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
ALA Application for Licensure by Endorsement or Credentials
Assisted Living Facility Administrator Application for Licensure
Endorsement Certification Form
ALA Application for Administrator-in-Training
Assisted Living Facility Administrator-in-Training Application
Monthly Report of Assisted Living Facility Administrator-In-Training
Completion of Assisted Living Facility Administrator-In-Training
ALA Application for Certification as a ALA Preceptor
Assisted Living Facility Administrator Preceptor Application