Arizona Department of Health Services (DHS) statutes
Arizona Revised Statutes: Article 6
Assisted Living Facility Manager Exam Study Resources
CEU extension request form
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
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
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
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
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
Frequently used forms:
Character Certification Form: https://nciaboard.az.gov/resources/character-certification-form
Paycheck Hours Worked Tracker: https://nciaboard.az.gov/resources/paycheck-hours-tracker
Hours Worked Certification Form (Must Accompany proof of pay, i.e., W2, 1099) https://nciaboard.az.gov/resources/hours-worked-certification-form
How to Start an Administrator License Application
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
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
This spreadsheet can be used when submitting individual paycheck stubs to document 2080 hours worked.
Public Records request form
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
Request for a Copy of Original Certificate or License
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 $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]
Temporary License
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