Forms and Applications

The following applications and forms are for use by nursing homes and those seeking an initial license.

Nursing Home Application

Change of Ownership (CHOW)

Bed Breakdown

These are the forms needed for making a change to the number of certified beds in a nursing facility.

Administrator and Director of Nursing Change

Nursing homes are required to notify the Nursing Home Licensure and Certification Section within one working day following the occurrence of change in administrator or director of nursing. Please submit the completed Admin-DON Change form to [email protected].

Civil Money Penalty Reinvestment Program

Eligible applicants applying for Civil Money Penalty funding in North Carolina are required to use RFA 2474. Links to the application forms and resources you will need to complete your application, including the CMP Application Form, CMP Project Budget Spreadsheet, and the CMP Applications Handbook, are located on page 5 of the RFA.

Links to Other Government Forms