Nursing Home Administrator

Pursuant to 2017 Wisconsin Act 278, beginning August 1, 2018, prior to submitting an application for a credential, an individual may apply to the Department for a determination of whether the individual would be disqualified from obtaining the credential due to his or her conviction record.  To apply for a predetermination, please fill out Form #3085 and submit all required documentation specified on the form.  Pursuant to Wis. Stat. § 111.335(4)(e), the offenses or kinds of offenses that may result in a refusal, bar, or termination of licensure are published under Additional Resources on the left side of this page.


License Information

Fee Reduction

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.

Per 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.

Approved courses can be found on the Application for Nursing Home Administrator License (Form #418).


Application for Licensure

FormDescription
1573Application for Examination
418Application for Nursing Home Administrator License
​3217​Application for Fee Reduction (This form must accompany the application for the credential)
71Verification of Experience in the Field of Institutional Administration (if applicable)
2470Reciprocity Experience Record (Reciprocal Applicants Only)
419Verification of Licensure (Reciprocal Applicants Only)
​3085​Application for Predetermination
2252​Convictions and Pending Charges
3071​Fax Payment Form

Renewal Information

Requirements

  • FEE (See Renewal Dates and Fees)
  • SIG  (Signature regarding the completion of Continuing Education, see Continuing Education Information, included in on-line renewal and paper form)
  • If your legal status as a qualified alien or nonimmigrant lawfully present in the United States has changed since the issuance of your credential or your last renewal, please contact the Wisconsin Department of Safety and Professional Services at (608) 266-2112 or dsps@wisconsin.gov.

Renewal Methods

  • Online Log In: License Renewal Online
  • Request a Paper Renewal Form: (888) 506‑4239 or (608) 261‑4460 for the Madison area

FormDescription
RDAFRenewal Dates and Fees
R210Active Duty/Discharge Renewal Extension

Wisconsin Act 210 (effective June 1, 2012)

This Act extends the license of a service member if the license expires while they are on active duty from 90 days to 180 days from the date of discharge. The same applies to a spouse of a service member if the spouse does not practice under their license while the service member is on active duty and does not practice because the service member is on active duty.

This Act repeals a provision of prior law that required a service member to meet all of the requirements for license extension or renewal, except for continuing education requirements, in order to have the license extended.

Service members and spouses may request extensions of licenses beyond 180 days from discharge and may request a waiver or extension of time to complete continuing education requirements due to hardship. Please view Active Duty/Discharge Renewal Extension Form #R210.