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Applications & Forms

Board of Nursing Home Administrators

Application for Initial Licensure and Licensure by Reciprocity 
*Re-Application – Previously licensed but license expired more than one year ago
pdf file Application for Licensure
word document Application Instructions
word document Reference Letter

Application for Temporary Emergency License and Extension
pdf file Temporary Emergency License
pdf file Application for Licensure
word document Reference Letter
pdf file Temporary Emergency License Extension

Continuing Education Offering/Training Agency Application
word document Single Offering Application
word document Training Agency Application

2008 License Renewal
pdf file 2008 License Renewal Form

Retire NHA License
pdf file Application to Retire NHA License

Inactive NHA License
pdf file Application for Inactive Status of a Missouri Nursing Home Administrator License

Miscellaneous Forms and Information
word document Change Personal Information/Duplicate License Request
word document Complaint Form
word document Directions to BNHA Office
word document Fee Schedule
word document Preceptor Application

State/National Examination
word document Application for State Examination (for candidates previously found qualified to test)
      2008
pdf file NAB Candidate Handbook
word document State and NAB Sources of Study