Issuance Fee

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First Name

Last Name

Email

Phone Number

R4-33-211 (Administrators) and R4-33-410 (Managers) Requires Licensees to Submit a Notice of appointment, within 30 days, of being appointed Administrator or Manager of a facility, or upon Termination. Notice of Appointments are submitted in the Licensee Portal. The Licensee Portal becomes available to you once your license is issued. The Licensee Portal link can be found on the Board's website https://nciaboard.az.gov

Initial Certification Fee

Select your issuance fee

Manager Certificate Issuance Fee Cost

Administrator License Issuance Fee Cost