Existing Licensees:  To notify the Board of your start or end date at a facility, please log in to your Licensee Portal and complete the Notice of Appointment information found under Requests on the left navigation pane.

This spreadsheet can be used when submitting individual paycheck stubs to document 2080 hours worked.

If your original license has been lost or destroyed, please complete the Request for a Copy of Original Certificate or License form. You will pay the $91.50 fee at nciapay.az.gov and select "Issuance Fee".  You will be emailed a receipt.  After you receive your receipt, please email your form and your receipt to [email protected]

Create your account in the Applicant Portal

Choose:  "New user?  Apply Now"

For Administrator License Requirements, please review all of Article 2 of the Board Rules found at: https://nciaboard.az.gov/about/board-directory-rules  

Frequently used forms:

Create your account in the Applicant Portal

Choose:  "New user?  Apply Now"