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Home Nursing Care Institution Administrators and Assisted Living Facility Managers

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Name Change

Read more about Name Change

Change of Address

Read more about Change of Address

To change your mailing address fill out the attached form and follow the instructions to submit the form. 

How to Start an Administrator License Application

Read more about How to Start an Administrator License Application

How to Start a Manager Certificate Application

Read more about How to Start a Manager Certificate Application

Statement of Citizenship Form

Read more about Statement of Citizenship Form

Character Certification Form

Read more about Character Certification Form

Letter of Intent to Appoint a Temporary Manager

Read more about Letter of Intent to Appoint a Temporary Manager

Letter of Intent to Appoint a Temporary Manager.  This form should be submitted with an initial application for a manager certificate or uploaded with the service request in the e-licensing portal. Mail or fax forms will not be accepted.

Letter of Intent to Appoint a Temporary Administrator

Read more about Letter of Intent to Appoint a Temporary Administrator

Letter of Intent to Appoint a Temporary Administrator.  This form should be submitted with an initial application for temporary licesne or uploaded with the service request in the elicense portal.  Mail or fax forms will not be accepted.

Public Records request form

Read more about Public Records request form

Public Records request form is use for requesting copies of public records from the Board or requesting administrator and manager mailing lists.

Duplicate Manager Certificate request form

Read more about Duplicate Manager Certificate request form

Duplicate Manager Certificate request form must be filled out and uploaded with the service request in the elicense portal.  Mail or fax forms will not be accepted.

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Contact

Arizona Board of Nursing Care
Institution Administrators and Assisted Living Facility Managers
 

1740 W. Adams Street, Suite 2490

Phoenix, Arizona 85007

Phone: (602) 364-2374

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