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 7/25/2008
- Endorsement Verification Form - rev 03/28/2008
Application for Initial Licensure
Application for Administrator-In-Training
- Domains of Practice - rev 11/09/2009
- Core of Knowledge - rev 10/03/2007
- Application for Administrator-in-Training - rev 10/26/2009
- Monthly Report for AIT - rev 10/03/2007
- Documentation of Completion Form - rev 08/04/2008
- 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 7/25/2008
- 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:
ALF-AIT Education and Experience Matrix
Assisted Living
Facility Administrators Education and Experience Matrix - rev. 09/04/2008
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 - rev. 04/28/2009
ALA Application for Licensure by Endorsement or Credentials
Assisted Living Facility Administrator Application for Licensure - rev. 04/28/2009
Endorsement Certification Form
ALA Application for Reinstatement
Assisted Living Facility Administrator Application for Reinstatement– 10/27/2009
ALA Application for Administrator-in-Training
Assisted Living Facility Administrator-in-Training Application - rev. 11/17/2009
Monthly Report of Assisted Living Facility Administrator-In-Training
Completion of Assisted Living Facility Administrator-In-Training
Domains of Practice
- rev. 11/09/2009
ALA Application for Certification as a ALA Preceptor
Assisted Living Facility Administrator Preceptor Application rev. 09/04/2008