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  • Preceptor Application - State Of Indiana - In

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IONAL LICENSING AGENCY 402 West Washington Street, Room W072 Indianapolis, Indiana 46204 Telephone: (317) 234-2051 E-mail: pla6 pla.IN.gov *Social Security number is required pursuant to I.C. 4-1-8-1. APPLICATION FEE: DATE FEE PAID: RECEIPT NUMBER: PRECEPTOR NUMBER: DATE ISSUED: DO NOT WRITE ABOVE THIS LINE APPLICANT INFORMATION Name (last, first, middle, maiden) *Social Security number Residential address (number and street or rural route) Email address City, state, and ZIP code Telephone n.

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Completion of a specialized course of study in long-term health care OR residential care administration prescribed by the Indiana State Board of Health Facility Administrators. Completion of a six (6) month administrator-in-training program supervised by a board certified preceptor.

a baccalaureate degree or higher in any subject from an accredited institution; OR. an associate degree in health care from an accredited institution and completion of a specialized course of study in long term health care administration prescribed by the Indiana State Board of Health Facility Administrators; OR.

After submitting an application to the Indiana Professional Licensing Agency (IPLA) and completing a five to six month Administrator-in-Training (AIT) or internship experience in a residential care or health care facility, an AIT must then complete an RCA/HFA Course and pass the licensing exam.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232