Pursuant to 2017 Wisconsin Act 319, beginning August 1, 2018, an applicant for an initial credential may apply for a reduction of the initial credential fee that is equal to 10% of the initial fee. Qualification is based on the federal adjusted gross income being at or below 180% of the federal poverty guideline prescribed for the applicant's family household size by the United States Department of Health and Human Services. To determine eligibility please visit the United States Department of Health and Human Services website at https://aspe.hhs.gov/poverty-guidelines, prior to submitting Form 3217.
Wis. Stat. § 440.08 (2), the required renewal date for the Nursing Home Administrator credential is 06/30/even years. Should you receive your initial credential in the months leading up to this date, you are still required to renew your license by the statutorily defined date.
Pre-Credential Education Information
Applicants must complete a regular course of study, a program of study, or complete specialized courses which the Nursing Home Administrator Examining Board considers adequate academic preparation for nursing home administration.
Current NHA Approved Course List.pdf
Application for Licensure
1573||Application for Examination|
418||Application for Nursing Home Administrator License|
|3217||Application for Fee Reduction (If applying for a fee reduction, this form must accompany the application for the credential.)|
71||Verification of Experience in the Field of Institutional Administration (if applicable)|
2470||Reciprocity Experience Record (Reciprocal Applicants Only)|
419||Verification of Licensure (Reciprocal Applicants Only)|
3085||Application for Predetermination (Optional-Submit ONLY if you have been convicted of any felony, misdemeanor, or other violations of federal or state law in this state or any other and you desire a review of your conviction record before applying for a credential.)|
2252||Convictions and Pending Charges (if applicable)|
3071||Fax Payment Form|