Certified Administrator Application Process Guide
This file provides detailed instructions on how to become a certified administrator for various care facilities. It includes application requirements, examination details, and important deadlines. Users seeking certification in RCFE, ARF, GH, or STRTP will find essential information here.
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How do I fill this out?
To fill out this application, gather all necessary documents and information before beginning. Ensure that you meet the qualifications for the specific program you are applying for. Follow the detailed steps provided in the application to ensure proper submission.

How to fill out the Certified Administrator Application Process Guide?
1
Review the qualifications for the specific administrator certification.
2
Complete any necessary training programs or certifications required.
3
Gather the required documents, including your application form and payment.
4
Submit your application packet to the appropriate address within the specified timeframe.
5
Follow up on your application status and be prepared for any further requirements.
Who needs the Certified Administrator Application Process Guide?
1
Individuals seeking certification as RCFE administrators.
2
Professionals aiming to transition from GH to STRTP administration.
3
NHA licensed individuals wanting to become RCFE administrators.
4
Applicants needing a clear guide for completing their certification application.
5
Organizations hiring new administrators for elder care facilities.
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What are the instructions for submitting this form?
To submit this form, ensure all required documents are included in your application packet. You may send your completed application via certified mail to the Administrator Certification Section at the address provided. Alternatively, check if online submission options are available for quicker processing.
What are the important dates for this form in 2024 and 2025?
In 2024, important dates include the start of the certification application season in March and the deadline for submissions by June 15th. In 2025, look for similar timelines with potential adjustments based on departmental guidelines. Ensure to check for updates throughout both years.

What is the purpose of this form?
The purpose of this form is to guide prospective administrators through the certification application process for Residential Care Facilities for the Elderly, Adult Residential Facilities, Group Homes, and Short-Term Residential Therapeutic Programs. It outlines qualifications, required training, and submission procedures. This ensures all applicants are well-informed and compliant with necessary regulations.

Tell me about this form and its components and fields line-by-line.

- 1. Application for Administrator Certification: The primary form that needs to be filled out by the applicant.
- 2. LIC 9214: The specific application form for the administrator certification.
- 3. LIC 508 Criminal Record Statement: A statement regarding the applicant's criminal history.
- 4. LIC 9163 Request for Live Scan: A form required for state and national criminal background check.
- 5. Payment Information: Details regarding the payment method for application processing fees.
What happens if I fail to submit this form?
Failure to submit this form can result in delays in obtaining certification. If your application is incomplete, you may receive notices requiring additional information or resubmission. Failing to act upon such notifications can lead to eventual denial of your certification.
- Application Delay: Submitting an incomplete application may cause significant delays in processing.
- Reapplication Requirement: You might need to reapply and fulfill additional training if not submitted correctly.
- Certification Denial: Lack of proper submission could lead to a denial of your certification application.
How do I know when to use this form?

- 1. Initial Certification Application: For new applicants seeking certification to operate care facilities.
- 2. Certificate Renewal Application: For existing administrators whose certification is expiring.
- 3. Change of Administration: To transfer certification between different facilities.
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