Applications & Forms

If a fee is included please mail to one of the following addresses!

Regular Mailing Address

Overnight Mailing Address

Department of Health & Senior Services
Board of Nursing Home Administrators
ATTN: FEE RECEIPTS
PO Box 570
Jefferson City, MO 65102-0570

Department of Health & Senior Services
Board of Nursing Home Administrators
ATTN: FEE RECEIPTS
920 Wildwood Drive
Jefferson City, MO 65109-5796

Application for Initial Licensure and Licensure by Reciprocity (for NHA License)

Application for Licensure
Application Instructions

 

Application for Initial Licensure and Licensure by Reciprocity (for RCAL License)

Application for Licensure
Application Instructions

 

Application for Temporary Emergency License and Extension (for NHA License)

Temporary Emergency License
Temporary Emergency License Extension

 

Application for Temporary Emergency License and Extension (for RCAL License)

Temporary Emergency License
Temporary Emergency License Extension

 

Continuing Education Offering/Training Agency Application

Single Offering Application
Training Agency Application

 

NHA License Renewal

NHA Application for License Renewal

 

RCAL License Renewal

RCAL Application for License Renewal

Retire Administrator License – Only Available At the Time of Renewal

Application to Retire Administrator License

 

Inactive Administrator License – Only Available At the Time of Renewal

Application for Inactive Status of Administrator License

 

Miscellaneous Forms and Information

Change of Personal Contact Information and/or Employment Information
Duplicate/Replacement License Request 
Name Change Request 
Complaint Form
Directions to BNHA Office
Fee Schedule
Preceptor Application

 

State/National Examination – the following is for those applicants that are currently found qualified

NHA State & NAB Exam Instructions
RCAL State & NAB Exam Instructions
State and NAB Sources of Study
State and NAB Sources of Study RCAL