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Virginia Administrative Code
Title 18. Professional And Occupational Licensing
Agency 95. Board of Long-Term Care Administrators
Chapter 30. Regulations Governing the Practice of Assisted Living Facility Administrators
11/21/2024

FORMS (18VAC95-30).

Checklist and Instructions for Assisted Living Facility Administrator Application for Licensure (rev. 3/2023)

Assisted Living Facility Administrators Education and Experience Matrix (rev. 12/2022)

Monthly Report of Assisted Living Facility Administrator-in-Training (rev. 12/2022)

Assisted Living Facility Administrator-in-Training Documentation of Completion Form (rev. 12/2022)

Assisted Living Facility Administrator-in-Training Notice of Change of Status or Discontinuance (rev. 7/2020)

Assisted Living Facility Administrator Preceptor Application (rev. 1/2024)

Proposed AIT Program Training Plan Domains of Practice (rev. 12/2022)

Assisted Living Facility Administrator Reinstatement Application (rev. 8/2024)

Preceptor Reinstatement Application (rev. 8/2024)

Checklist and Instructions for Assisted Living Facility Administrator-in-Training (rev. 3/2023)

Checklist and Instructions for Acting Assisted Living Facility Administrator-in-Training (rev. 3/2023)

Continuing Education Affidavit of Completion for Assisted Living Facility Administrators (rev. 12/2022)

Continuing Education (CE) Credit Form for Volunteer Practice (rev. 7/2020)

Name/Address Change Form (rev. 1/2021)

Request for Verification of Virginia Long-Term Care Administrators License (rev. 11/2019)

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