State Board of Nursing Home Administrators

Applications & Forms

Application Forms

To apply for a full or temporary license, by examination or endorsement please use the:

If you are applying by examination you will need to submit a completed:

All applicants are required to submit a copy of Lawful Presence with their application, please see list:

Miscellaneous Forms

If you are applying to another jurisdiction and they require official verification, there is a required fee of $30.00, payable by cashier's check or money order. Please complete and submit the form and fee:

If your address has changed, please email your name, license type and your new mailing address to:

If your name has changed, you must notify the Board within 30 days of the change, by submitting:

If you need a replacement wall certificate, you will need to submit the required fee and the form:

If you need to order a roster of current licensees, please complete the Roster Request form and email to The list will be in an Excel workbook, and will include licensee's name, work mailing address and email:

The Wyoming Board of Nursing Home Administrators is staffed through the Professional Licensing Boards Office, a division of A&I.