Apply to be a nursing home administrator in training (AIT)

Submit the following documents together by mail:

• A completed application form, signed and dated by the applicant and notarized
• A 2x2 passport style color photo (white or off-white background). Copies and printer generated photos aren't acceptable.
• A check or money order for the fee listed below.
• A signed and notarized Criminal Offender Record Information (CORI) Acknowledgement Form, found below.
• A written request from you for the proposed AIT internship. Include:
  • The name of the preceptor
  • The facility at which the training will take place
  • The name of the facility’s owner
  • The number of beds
  • Any requests for credit for academic and/or professional experience
• A letter from the proposed preceptor to the Board requesting that they be approved as the preceptor. The preceptor must be a Massachusetts licensed administrator in good standing with at least 5 years of Nursing Home Administration experience.
• A detailed outline of the proposed Internship
  • Note A: the Preceptor Guidelines can't be submitted as the internship outline
  • Note B: Once approved, the preceptor must submit a 3 and 6 months progress reports with completed hours directly to the Board of Registration of Nursing Home Administrators
• A signed agreement between the preceptor and the candidate. The agreement must state where the training will be held, the number of beds in the facility, and if it's a multi-level or skilled facility.
• Your current resume

The following documents must be received by the board in signed, sealed envelopes:

1. Official transcripts in signed, sealed envelopes for all undergraduate degrees and any other post-secondary degrees. When requesting official transcripts, please inform each school’s registrar that the transcript must be complete and state the degree and date conferred in mm/dd/yyyy format. The institutions should send transcripts directly to the Board.
2. Verification of licensure status, in signed, sealed envelopes, from any state or jurisdiction in which you now or have previously held any professional license. The State or jurisdiction must send verifications directly to the Board.
3. If you hold, or have ever held, any professional license or certification, you must request a National Practitioner Data Bank-Healthcare Integrity and Protection Data Bank Self-Query and submit the Original report in a signed and sealed envelope with this application. To request a Self Query, please contact the National Practitioner Data Bank. Keep a copy for your records.
   • Note: If you don't hold and have never held any professional licenses in any other state, you do not need to submit a National Practitioner Data Bank self-query.