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 with at least 2 years experience.
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 do not hold a current, active 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