Transfer a nursing home administrator license (application for reciprocity)

• Completed application
• Application fee amount of $225.00
• 2x2 passport style color photo
• White or off-white background
• Three professional references and one personal reference
  • Note: references may not be relatives, spouses, subordinates, or your AIT preceptor
• A completed physician form
• A completed Administrator Affidavit or State Verification Reciprocity Form from the state you are currently practicing as a nursing home administrator.
• Official transcripts for all undergraduate degrees and any other post-secondary degrees. Transcripts must be complete and state the degree and date conferred.
• The educational institution must send transcripts directly to the Board.
• A current resume or curriculum vitae that describes your long term facility experience and includes the name and complete address of all employers, dates of employment, position titles, and duties.
• Copy of a current valid Nursing Home Administrator license from the state in which you are practicing. The copy must provide the license number and expiration date.
• NAB credentialing exam score. To request a score, please contact the Interstate Reporting Service.
• Documentation of compliance with the Board’s continuing education requirements at the time of application for the current continuing education cycle.
  • Note A: The Board requires at least of 40 contact hours of continuing education between July 1st of each even-numbered calendar year and June 30 of the next even-numbered calendar year.
  • Note B: If you have been licensed as a nursing home administrator for less than 19 months you are exempt from this continuing education requirement. Submit a written statement requesting the exemption.
  • Note C: The Board accepts certificates of attendance that clearly state the:
  • Licensee’s name 
  • Date(s) of the program 
  • Title of program 
  • Number of contact hours of continuing education awarded
  • Information that documents that the program has been approved by NAB or the Board.
• National Practitioner Data Bank-Healthcare Integrity and Protection Data Bank Self-Query. To request a Self-Query, please contact the National Practitioner Data Bank. The Self-Query must be submitted to the Board without any modifications.

Signed and notarized Criminal Offender Record Information (CORI) Acknowledgement Form (PDF) | (DOCX)

If applicable

• Official verification of licensure from any state or jurisdiction in which you now or have previously held any professional license, including expired license(s)
  • The state or other jurisdictions must send verifications directly to the Board.
• If you answer "yes" to any of the Professional and Criminal History Questions:
  • Submit a personal statement explaining the circumstances.
  • Submit all supporting documentation (police reports, court documents, disciplinary consent agreements, etc.)