Administrator in Training - AIT Program

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
Arizona Chapter, American College of Healthcare Administrators
Misti Valentino-AIT PAC Chair

Email: [email protected]
Cell: (702)-273-7800

AZ AIT Program Advisory Committee
1959 South Power Road, Ste 103-359
Mesa, AZ  85206

CEU extension request form can be used between April 30th and July 31st 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 all required attachments as a service request in the elicense portal.

Continuing Education

The NCIA Board has partnered with CE Broker for your continuing education needs.  To search for Board Approved Continuing Education Providers, visit https://cebroker.com/

How do I create a FREE Basic Account?

1.  Visit https://cebroker.com/az/account/basic/

2.  Enter your license or certificate number

3.  Create a username and password

The Basic Account allows you to search for board-approved continuing education providers.  For other account-type options, please visit https://cebroker.com/plans

How do I search for approved courses?

1.  Visit https

The Duplicate Administrator License request form must be filled out completely.  During the system migration period, pay your $75 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].

The Duplicate Manager Certificate request form must be filled out completely.  During the system migration period, pay your $75 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].

Beginning 11/30/2023 at 5pm, applications will NOT be accepted during the system migration period.  Please check the home page for updates.

Frequently used forms:

Arizona Statement of Citizenship Form: https://nciaboard.az.gov/resources/statement-citizenship-form

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

5-Year Residence History: https://nciaboard.az.gov/resources/5-year-resident-history

5-Year Employment Record Form: https://nciaboard.az.gov/resources/5-year-employment-record

Paycheck Hours Worked Tracker: https:/

Beginning 11/30/2023 at 5pm, applications will NOT be accepted during the system migration period.  Please check the home page for updates.

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
Arizona Chapter, American College of Healthcare Administrators
Misti Valentino-AIT PAC Chair

Email: [email protected]
Cell: (702)-273-7800

AZ AIT Program Advisory Committee
1959 South Power Road, Ste 103-359
Mesa, AZ  85206

The Letter of Intent to Appoint a Temporary Administrator can be emailed to inform[email protected] Mailed or faxed forms will not be accepted.

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.

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

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

Request for a Copy of Original Certificate or License. During the system migration period, pay your $75 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]