Application For Licenses As An Assisted Living Administrator
Please note that the following exhibits must be returned with this completed application and notarized.
A copy of the applicant's driver's license or any other proof of age.
Classroom Training and Test Dates
form with applicant's dates of registration checked.
A copy of the facility's state license from ADPH.
A copy of the applicant's high school diploma or GED (or letter from school)
Proof of at least one year of experience working fulltime in an administrative or resident or patient care position in a licensed assisted living facility, nursing home, hospital or residential care setting for the elderly or disabled within two years preceding date of this application with the enclosed
Endorsement form Employer
form completed by the administrator, owner, or governing authority of such facility.
A copy of the applicant's college diploma or transcript showing evidence of at least two years. (60 semester hours or 96 quarter hours) of coursework at an accredited college or university.
Proof of either at least three months of experience working fulltime in an administrative or resident or patient care position in a licenses assisted living facility, nursing home, hospital, or residential care setting for the elderly or disabled
of completing a minimum of 240 hours of a Board approved internship within two years preceding date of this application.
Please note that if you do not provide proof of this prior work experience of intership, you must complete and submit the enclosed Commitment to Fulfill Experience Requirement for with application.
Your application will not be considered complete until all of the exhibits above and required supporting documentation have been received. Your complete application and required documents must be postmarked at least 30 days prior to the Section A testing for which the applicant registers.
I hereby make application for License as an Assisted Living Administrator in the State of Alabama. Following completion and acceptance of my application, I request to sit for the following assisted living licensure examination.
Category I Administrator (to administer Assisted Living Facilities)
Category II Administrator (to administer Assisted Living Facilities, Specialty Care Assisted Living Facilities, or a combination)
Policy Related Questions: 334-271-2418Technical Support: 866-353-3468 or