Transfer a nursing home administrator license (application for reciprocity)
Contact for Transfer a nursing home administrator license (application for reciprocity)
Board of Registration of Nursing Home Administrators
The Details of Transfer a nursing home administrator license (application for reciprocity)
What you need for Transfer a nursing home administrator license (application for reciprocity)
You must provide all requested information. Failure to provide requested information may result in a delay in processing your application. Incomplete applications will be returned to applicant.
Completed Applications must include the following:
- The following documents must be submitted at the same time in one envelope:
- A completed application form, signed and dated by the applicant and notarized
- A 2 x 2 passport style color photo (white or off-white background). Copies and printer generated photos are not acceptable.
- A signed and notarized Criminal Offender Record Information (CORI) Acknowledgement Form, found below
- A check or money order, payable to the Commonwealth of Massachusetts, for the fee listed below
- Three professional references
- Note: they can't be relatives, spouses, family members, subordinates ,or your AIT preceptor
- One personal reference.
- Note: they can't be a spouse, partner, family member, subordinate or your AIT preceptor
- A completed physician form
- A completed Administrator Affidavit
- Note: Provide a self-addressed envelope to your endorsers with your Reference Forms, Physician Form, and Administrator Affidavit Certificate of Internship Training. After the individual has completed the form, they must seal it in the return envelope you provide, sign their name across the envelope seal, and return it to you.
- 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.
- 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.
- State Verification Form from the state you are currently practicing as a nursing home administrator in a signed, sealed envelope. The state or jurisdiction must send verifications directly to the Board.
- 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.
- 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.
- NAB credentialing exam score in a signed, sealed envelope from the Interstate Reporting Service. 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
American College of Healthcare Administrators Members:
If you hold a current valid license as a nursing home administrator in another state and also hold current certification as a nursing home administrator from the American College of Healthcare Administrators, you can submit the following documents instead of the materials listed in #3-9:
- Copy of a current valid Nursing Home Administrators license from the state in which you are practicing. The copy must provide the license number and expiration date.
- Verification from the state you are currently practicing in that your license is in good standing in a signed, sealed envelope
- Authenticated verification from the American College of Healthcare Administrators of current certification in a signed, sealed envelope
Fees for Transfer a nursing home administrator license (application for reciprocity)
- We accept checks or money orders. Make it payable to the Commonwealth of Massachusetts.
- All fees are non-refundable and non-transferable
- Please don't staple payment to the application
- Please don't send cash or foreign currency
|Handling charge for returned checks||$23||each|
|Nursing Home Administrator - Application by Reciprocity||$225||each|
How to apply Transfer a nursing home administrator license (application for reciprocity)
- Download the application by reciprocity, found below
- Complete the application
- Please submit on single-sided pages
- Include the fee and all attachments
- Don't leave any blanks. If you're unable to provide the requested information, attach a separate sheet with an explanation. Missing information will delay the processing of your application.
- Mail completed application and all attachments to:
Board of Registration of Nursing Home Administrators
239 Causeway St.
Boston, MA 02114
Next steps for Transfer a nursing home administrator license (application for reciprocity)
Keep a copy of the complete application and supporting documentation for your records. Employers may require that you provide them with a copy.
The Board is not able to provide copies of the application.