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 $20.00, 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 maxie.hernandez@wyo.gov. The list will be in an Excel workbook, and will include licensee's name, work mailing address and email: