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Form 5518NFA January 2022ENursing Facility Administrator ProgramProvisional Licensure Questionnaire Section 1: Applicant Information (To be completed by the applicant.) Note: Completed forms and documents.

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How to fill out the TX Form 5518-NFA online

Filling out the TX Form 5518-NFA online is a straightforward process that requires attention to detail and accuracy. This guide provides step-by-step instructions to help you complete the form efficiently, ensuring that all necessary information is included.

Follow the steps to fill out the TX Form 5518-NFA online.

  1. Press the ‘Get Form’ button to obtain the form and open it in your editor.
  2. Begin with Section 1: Applicant Information. Enter your name (last, first, middle) and maiden name if applicable. Fill in your Social Security number, email address, date of birth, and complete your street address, city, state, and ZIP code.
  3. Continue by providing your nursing facility administrator (NFA) license number and the date it was issued. Ensure all fields are filled out accurately.
  4. In the Employment Information section, include the name, street address, city, state, and ZIP code of your employer. Confirm whether you were the administrator of record at this facility and indicate your dates of employment.
  5. Proceed to fill out the Provisional License Sponsor details with the name and license number of the NFA that will sponsor you during provisional licensure.
  6. In the Applicant's Authorization and Signature section, affirm your authorization for the release of licensure information by signing and dating the form.
  7. Section 2 is to be completed by the state where you are currently active. Ensure this section is returned to you once completed.
  8. Complete the fields related to your license number, current status, and expiration details as applicable. Note your internship information, including completion date and hours completed, and indicate if it is part of an NAB-accredited program.
  9. Specify education details, including whether you have a bachelor's or master's degree, the name of the degree(s) awarded, and ensure the minimum credit hours in long-term care administration are acknowledged.
  10. Answer the examination questions regarding NAB exam and state exam specifics. If any disciplinary actions have been taken, provide the necessary details.
  11. Lastly, if required, have a representative of the state complete the notary section, including their signature, title, and notary seal.
  12. After completing the form, save your changes. You can then download, print, or share the form as needed.

Complete your TX Form 5518-NFA online today to ensure a smooth licensing process.

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