CEU extension request form can be used to request an extension of time to complete the CEU requirement for license or certificate renewal.  The form must be filled out and uploaded with your renewal, along with the CEU certificates you are submitting with your renewal.

A Duplicate Administrator license is $75.  To request a duplicate, log into your Licensee Portal and complete the required fields and payment in the Requests > Duplicate Certificate section found on the left navigation pane.

A Duplicate Manager Certificate is $75.  To request a duplicate, log into your Licensee Portal and complete the required fields and payment in the Requests > Duplicate Certificate section found on the left navigation pane.

Create your account in the Applicant Portal

Choose:  "New user?  Apply Now"

For Manager Certificate Requirements, please review Article 4 of the Board Rules found at: https://nciaboard.az.gov/about/board-directory-rules 

ARTICLE 4: ASSISTED LIVING FACILITY MANAGER CERTIFICATION
R4-33-401. Requirements for Initial Certification by Examination:
A. Except as provided in subsection (B), an individual who wishes to receive an initial certificate by
examination as an assisted living facility manager shall:
1. Education:
a. Earn a high school diploma or G.E.D, or hold a license in good

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:

Character Certification Form: https://nciaboard.az.gov/resources/character-certification-form

For applicants needing to complete an Administrator-in-Training Program (AIT) in Arizona or for information on how to become an AIT Preceptor, please contact:

Administrator-in-Training Program Advisory Committee

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.

The Public Records Request form is used for requesting copies of public records from the Board or requesting administrator and manager mailing lists. Please email your completed form to [email protected]  A member of our staff will contact you to advise of any fees that may be associated with your request.

A list of Licensees can be found, free of charge, on the Online Registry  

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]

To apply for a Temporary Administrator or Manager License, create your account in the Applicant Portal  Choose:  "New user?  Apply Now"

Letter of Intent forms for Temporary Administrator and Temporary Manager are found on page 2 at Resources

Temporary Manager Certificate Requirements are found in Article 4 of the Board Rules found at: https://nciaboard.az.gov/about/board-directory-rules

Temporary Manager Certificate Requirements are found in Article 2 of the Board Rules found at: https://nciaboard.az.gov/about/board-directory-rules