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Nurse Administrator Change Submission


Nurse Administrator Change Submission

Please use the “Submit Substantive Change” button to submit your completed Substantive Change Form. Please click here to download the appropriate template for a Change in Nurse Administrator: here.

Remember, a separate form and submission is required for each program type affected by the Nurse Administrator change.

Please read the information below carefully to ensure your submission is received.

All documentation must be submitted in PDF format only. PDFs created from scanned documents are only acceptable for supporting documentation (e.g., correspondence with a state regulatory agency), while the completed substantive change form must be as a searchable PDF format (i.e., a Word document saved as a PDF). For help creating a searchable PDF, click here.

Click “Submit Change” and a form will open on the current page. Please complete all fields and attach the required supporting documentation files. The Substantive Change Report Form should be submitted as its own individual file as shown below.

Supporting documentation should be added as separate files. Please do not submit the Substantive Change Report and supporting documents as a single file.



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