Please review the attached document for instructions prior to starting your application for an Administrator License.

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
Cell: (702)-273-7800
 

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.

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.

Notice of Appointment request form needs to be uploaded with the service request in the elicense portal when an Administrator or Manager either starts or ends a facility appointment.

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