Active Licensees
Frequently Asked Questions
Applicant Forms
NHA Request for Academic Course and/or Experience Review (PDF Fillable)
NHA Full Application from NHA Education Review (PDF Fillable)
NHA Application for Initial Licensure (PDF Fillable)
Temporary Acting Administrator Permit for Skilled Nursing Facility (PDF Fillable)
State Exam Feedback Questionnaire
Name Change/Correction Form
Lost License and Replacement License
Online Portal Technical Support Request
Request to Add or Update a Facility
Licensees Forms
HSE Shared Executive Application (PDF Fillable)
Minnesota HSE Non-Renewal Form
Mentor Evaluation of ALDIR/ALD Mentee
Mentorship Interest Form
Shared Director Agreement
NHA Licensee Shared Administrator Application
HSE & NHA CE Attestation and Record Sheet (PDF fillable)
LNHA Employment Interest Registry
NHA New Licensee Survey
Continuing Education Approval Application
Continuing Education Provider Mailing Label Request Form
Request for Continuing Education Provider Mailing List
Name Change/Correction Form
Lost License and Replacement License
Online Portal Technical Support Request
Request to Add or Update a Facility
See Forms & Tutorials
Minnesota Board of Executives for Long Term Services and Supports (BELTSS)