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Resources

CEU extension request form

Forms

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.

Continuing Education

Other

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/ to log in to your licensee portal

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

Duplicate Administrator License Request

Forms

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.

Duplicate Manager Certificate Request

Forms

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.

How to Start a Manager Certificate Application

Forms

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

How to Start an Administrator License Application

Forms

 

Create your account in the Applicant Portal

Choose:  "New user?  Apply Now"

For Administrator License Requirements, please review 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
Arizona

Notice of Facility Appointment

Forms

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.

 

Paycheck Hours Tracker

Forms

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

Public Records request form

Forms

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