State Board of Nursing Home Administrators

Applications & Miscellaneous Forms


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

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.


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