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Applications & Forms

Servicemembers’ Civil Relief Act (SCRA) – Provisions For Professional Licensing

SCRA (50 U.S.C. § 4025(a)) facilitates the professional license portability for servicemembers and their spouses who are relocating to another state pursuant to military orders.

Please click here to access the Active Duty Servicemember/Spouse License Portability Application.

To access the Board's Frequently Asked Questions regarding the Military Spouse Licensing Relief Act (MSLRA) and Service Members Civil Relief Act (SCRA), please click here.

Please select an application type:

Nursing Home Administrator-in-Training (AIT) Education and Experience Matrix

NHA Education and Experience Matrix

Application for Nursing Home Administrator Licensure

Please read the instructions below before beginning the application process:

Checklist and Instructions for NHA Application for Licensure

Click here to begin the online application process for licensure by Education, Endorsement or Credentials. 

Application for Nursing Home Administrator-In-Training

Please read the instructions below before beginning the application process:

Checklist and Instructions for NHA AIT

Click here to begin the online application process.

For a list of licensed Preceptors who volunteered their contact information be posted in a public directory, please see the Preceptor Directory.

NHA Preceptor Registration Application

Please read the instructions below before beginning the application process:

Checklist and Instructions for NHA Preceptors

Click here to begin the online application process.

For more information please read the the Preceptor FAQs.

Application for Reinstatement

Assisted Living Facility Administrator-in-Training (AIT) Education and Experience Matrix

ALF Education and Experience Matrix


ALFA Application for Licensure

Please read the instructions below before beginning the application process:

Checklist and Instructions for ALFA Application for Licensure

Click here to begin  the online application process for licensure by Education, Endorsement or Credentials.

 

ALFA Application for Reinstatement

 

Application for ALF Administrator-in-Training (AIT)

Please read the instructions below before beginning the application process:

Checklist and Instructions for ALFA AIT

Click here to begin the online application process.

For a list of licensed Preceptors who volunteered their contact information be posted in a public directory, please see the Preceptor Directory.

 

ALFA Preceptor Registration Application

Please read the instructions below before beginning the application process:

Checklist and Instructions for ALFA Preceptors

Click here to begin the online application process.

Name/Address Change

Name and Address Change Form

 

Visit NAB’s website and register to take the NAB exam.

Visit NAB's website to download a PDF or MSWord copy of their Candidate Handbook and register to take NAB.

Visit NAB's website to download a PDF copy of their AIT Program Manual.

Out-of-State Temporary Practice

 Out-of-state temporary practitioner reporting form

Reactivation of Nursing Home or Assisted Living Facility Administrators

Application for Reactivation (Inactive to Active) for NHA or ALFA

Board of Long-Term Care Administrators
Email: ltc@dhp.virginia.gov