State Board of Nursing Home Administrators

Applications & Miscellaneous Forms


Application Processing:

Once your file is received, you will receive an email from the Board Office confirming receipt and providing you a summary of any outstanding materials. As Board Staff supports this and several other licensing boards, this may take 3-7 days, depending on the volume of mail received.

Once your file is determined to be complete, Board Staff will email your file to an Application Review Committee for consideration. Review generally takes 1-3 weeks. Following approval, you will receive an email notice of approval and your license materials will be mailed to the preferred mailing address you provide on the application form.

NEW: Pursuant to 2022 Legislation and the emergency rules signed effective July 20, 2022, the Board is now authorized to require fingerprint background checks for all new applications for licensure.

Application Forms

Click a link below and print the form you need. These are not editable or fillable. You must open and print.

Application for License by Endorsement - For those with a current, active NHA license in good standing in another state.

Application for Temporary License - For those with a current, active NHA license in good standing in another state that only need a temporary 90 day license.

Application for License by Examination - For those who do not hold a current, active NHA license, but have completed AIT and need to sit for the NAB exams.

Application for a Provisional License - For those who have not held a NHA license, and will be completing the AIT and NAB exams.

Fingerprinting Requirements - Instructions for those submitting fingerprint checks with their applications for licensure. Required for ALL applicants.


AIT/Preceptor Forms

Click a link below and print the form you need. These are not editable or fillable. You must open and print.

AIT/Preceptor Plan and Agreement

AIT/Preceptor Certification of Completion


Miscellaneous Forms

Click a link below and print the form you need. These are not editable or fillable. You must open and print.

Address / Name Change - To update your name or contact information with the Board Office

License Verification Request - To have your Wyoming license verified to other jurisdictions or entities

Replacement Documents Request - To request replacement pocket cards or wall certificate