HFA & RCA Applications, Instructions, & Supporting Documentation
Important Note: Be sure to include an email address on the application as this is the preferred method of communication from the board. You will receive notification of your license issuance through email correspondence.
General Guidelines for all HFA and RCA Applicants
Health Facility Administrator
Residential Care Administrator
- Verification of State Licensure Form - May be submitted to states that you hold or have held any health profession license so that they can verify that license to Indiana. You may want to contact the state(s) prior to sending this; they may not need this form.
- Verification of Administrator-in-Training Program for Health Facility Administrator Licensure Form - Use if you have completed an administrator-in-training program for licensure in another state.
- Verification of Employment of Applicants for Health Facility Administrator Licensure Form - Only use this form to verify active work experience as a licensed HFA in another state.
- Application for Repeat Examination
- Repeat Exam Application Instructions
Forms for those who have been approved by the Indiana State Board of Health Facility Administrators to enter into the A.I.T. program: