Get Nursing Home Tennessee Benha Form

Filling out the Nursing Home Tennessee Benha Form online is an essential step for individuals applying to become a preceptor or establishing a training facility. This guide provides clear and supportive instructions to help users navigate each section of the form effectively.

Follow the steps to fill out the Nursing Home Tennessee Benha Form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your full name in the designated fields: last name, first name, and middle name.
3. Provide your business address, including street and number, city, state, and zip code.
4. Input your telephone number, ensuring to include the area code.
5. Indicate your date of birth and social security number in the specified sections.
6. Enter your nursing home administrator's license number along with the date your original license was issued in Tennessee.
7. Respond to the question regarding the activity status of your license, marking 'Yes' or 'No' and providing further details if necessary.
8. Review the criteria for becoming a preceptor and provide necessary details and history if applicable, including licensure and employment experience.
9. Document your educational history, focusing on college credits and relevant experiences.
10. Complete the section regarding any disciplinary actions taken against your license, explaining if applicable.
11. Sign the application, ensuring that the facts provided are true and correct, and include the date.
12. Have the application notarized, following the instructions for the notary public's signature and commission expiration.
13. Lastly, save the completed document, download a copy, or print it for submission, ensuring that all documents are prepared for mailing to the appropriate board office.

Complete your Nursing Home Tennessee Benha Form online today and take the next step in your professional journey.