Healthcare Branch Board of Examiners of Nursing Home Administrators
APPLICATION FOR APPROVAL I hereby apply to be admitted to the Administrator-In-Training (AIT) program by the Board of Examiners of Nursing Home Administrators, in accordance with Section 12-39-107, C.R.S. and Board Rule III for the purpose of acting as an AIT. I am familiar with the applicable rules, regulations, and statutes pertaining to the AIT program and fully understand the responsibilities and reporting requirements contained therein and agree to comply with them. Attached please find my detailed program of study including the methods of instruction, which my preceptor and I submit for your approval for training at____________________________________________________________________________________Nursing Home. Will you be otherwise employed in a nursing home during the time of your AIT program?
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If YES, how many hours per week?
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What time of day?
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In what position?
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How many hours will be dedicated to the AIT program exclusive of employment?
YES
Describe how you will accomplish your described program in the hours aside from your employment:
Describe any existing relationship that exists with the preceptor:
AIT Signature:
Date:
Preceptor Signature:
Date:
1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800
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Aug 15, 2013 - physical geography, geo-ecology, hydrology, environmental studies or ... modeling (e.g. hydrological model, ecosystem model), as well as ...
... Practice Internship Manualâ. Healthcare Branch. Board of Examiners of Nursing Home. Administrators. Page 1 of 1. AIT - Program Plan Recommendations.pdf.
Board of Examiners of Nursing Home. Administrators. Page 1 of 1. AIT - Experience Verification Form.pdf. AIT - Experience Verification Form.pdf. Open. Extract.
AIT - Preceptor Statement Form.pdf. AIT - Preceptor Statement Form.pdf. Open. Extract. Open with. Sign In. Main menu. Displaying AIT - Preceptor Statement ...
Note: All documents submitted with the application must be either in the ... 197 â computer-based, min. ... courses), work experience and language proficiency.
Dependent Children (minors and incapacitated):Please indicate status (i.e., legitimate, legally adopted, acknowledged, illegitimate). Name. Date of Birth. Mailing Address. Status. With Incapacity. Yes No. Yes No. Yes No. Yes No. Yes No. C. SECONDARY
1) complete the application form either online or in hard copy. ... Degree seeking applicants are typically required to conduct an interview in person or via phone.
Download. Connect more apps... Try one of the apps below to open or edit this item. Scholarship for Masters at AIT ( Salai Om Ki).pdf. Scholarship for Masters at ...
Name of School. High School. City/State. Did you ... How funny would you say you are on a scale of 1-10 (10 being the most hilarious)? 1 2 3 4 5 6 7 8 9 10.
By signing this application, I authorize the Association, (including local, state and national) or their subsidiaries or representatives to fax, e-mail, telephone or ...
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(e-mail address if available). BUSINESS. YEARS ACQUAINTED. I understand and agree that I may be required to undergo fingerprinting and/or a background check as a condition of volunteering for this organization. I agree to comply with all OCFS regulat
Address. Business Phone .... Duties: Name and Location ofInstirution I. Hrs. ,. Degree. Majoror SpecialtyI. Minor .... degree o Graduate stUdybeyond master's.
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Alien's passport. Seaman's passport. Other travel document ... (State who and how and present corresponding documentation. * 36. Means of support during ...
into the detailed information from which a product ... COURSE OUTLINE. ⢠Introduction to Emerging ... Computer Science, Information Technology, Software.
Complete and sign the admission application including residency statement and submit to the Admissions. Office in ... Information provided on the admission application is used solely for our computer data base. If any of ... RCC does not participate
