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Applying for Licensure
AIT & Preceptor Agreement
(Administrator in Training)
AIT Word Format (*.doc)
AIT Adobe Format (*.pdf)
Preceptor Agreement (*.doc)
Preceptor Agreement (*.pdf)
Preceptor Hours of Work Verification Form (*.doc)
Preceptor Hours of Work Verification Form (*.pdf)
College Internship Policy (*.doc)
College Internship Policy (*.pdf)
(License by Exam) Word Format (*.doc)
Adobe Format (*.pdf)
(Reciprocity & Endorsement Form) Reciprocity Word Format (*.doc)
Reciprocity Adobe Format (*.pdf)
Endorsement Form in Word Format (*.doc)
Endorsement Form in Adobe Format (*.pdf)
For free Adobe Acrobat Reader Click Here

West Virginia Nursing Home Administrators Licensing Board
P.O. Box 522
Winfield, WV 25213
Telephone (304) 586-4070 | Fax (304) 586-4079
E-mail - veronica.s.cummings@wv.gov

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