Form NH-8 "Application for Approval of Administrative Intern Program" - New Jersey

What Is Form NH-8?

This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2021;
  • The latest edition provided by the New Jersey Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form NH-8 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.

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Download Form NH-8 "Application for Approval of Administrative Intern Program" - New Jersey

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New Jersey Department of Health
Nursing Home Administrators Licensing Board
APPLICATION FOR APPROVAL OF ADMINISTRATIVE INTERN PROGRAM
Mailing Address:
Overnight Services (UPS, FedEx, Airborne):
120 South Stockton Street, 3rd Floor
PO Box 358
Trenton, NJ 08625-0358
Trenton, NJ 08608-1832
INSTRUCTIONS: Complete as much information as possible on the form itself, then attach additional sheets as necessary and
number the response(s) to correspond to the numbers listed on this form. Please print or type.
1. Name of Applicant
2. Name of Licensed Long Term Care Facility Site
First
M.
Last
Street Address
Street Address
Zip
City
State
Zip
State
City
4. Personal Email Address
3. Social Security No.
5. Home Telephone Number
6. Work Telephone Number
7. Type of Program
Administrative Intern Program
Equivalency-Graduate School Program
(N.J.A.C. 8:34-4.2)
(N.J.A.C. 8:34-4.4)
8. If a waiver of any of the hours is being requested, state the specific reasons that justify this and attach any supporting documentation.
(To be completed by the applicant) (N.J.A.C. 8:34-1.8)
9. Total Number of Hours to be Completed
10. Program Start Date
11. Anticipated Completion Date
12. Outline the time the applicant will spend in each required area and attach sheet with WP for Administrative Intern (created by preceptor only
and outlining the type of experience that will be provided to the applicant).
13. Date
14. Signature of Applicant
STATEMENT BY PRECEPTOR FOR ADMINISTRATIVE INTERN PROGRAM
I am currently and have been licensed as a Nursing Home Administrator in New Jersey for at least five (5) years and have actively
practiced as a Nursing Home Administrator in a long term care facility for the immediate past three (3) years (N.J.A.C. 8:34-4.3).
15. Name of Preceptor (Must be Licensed Nursing Home Administrator)
16. NJ License Number
17. Date
18. Signature of Preceptor
FOR STATE USE ONLY
Approved
Date of Approval
Signature
Yes
No
NH-8
AUGUST 21
New Jersey Department of Health
Nursing Home Administrators Licensing Board
APPLICATION FOR APPROVAL OF ADMINISTRATIVE INTERN PROGRAM
Mailing Address:
Overnight Services (UPS, FedEx, Airborne):
120 South Stockton Street, 3rd Floor
PO Box 358
Trenton, NJ 08625-0358
Trenton, NJ 08608-1832
INSTRUCTIONS: Complete as much information as possible on the form itself, then attach additional sheets as necessary and
number the response(s) to correspond to the numbers listed on this form. Please print or type.
1. Name of Applicant
2. Name of Licensed Long Term Care Facility Site
First
M.
Last
Street Address
Street Address
Zip
City
State
Zip
State
City
4. Personal Email Address
3. Social Security No.
5. Home Telephone Number
6. Work Telephone Number
7. Type of Program
Administrative Intern Program
Equivalency-Graduate School Program
(N.J.A.C. 8:34-4.2)
(N.J.A.C. 8:34-4.4)
8. If a waiver of any of the hours is being requested, state the specific reasons that justify this and attach any supporting documentation.
(To be completed by the applicant) (N.J.A.C. 8:34-1.8)
9. Total Number of Hours to be Completed
10. Program Start Date
11. Anticipated Completion Date
12. Outline the time the applicant will spend in each required area and attach sheet with WP for Administrative Intern (created by preceptor only
and outlining the type of experience that will be provided to the applicant).
13. Date
14. Signature of Applicant
STATEMENT BY PRECEPTOR FOR ADMINISTRATIVE INTERN PROGRAM
I am currently and have been licensed as a Nursing Home Administrator in New Jersey for at least five (5) years and have actively
practiced as a Nursing Home Administrator in a long term care facility for the immediate past three (3) years (N.J.A.C. 8:34-4.3).
15. Name of Preceptor (Must be Licensed Nursing Home Administrator)
16. NJ License Number
17. Date
18. Signature of Preceptor
FOR STATE USE ONLY
Approved
Date of Approval
Signature
Yes
No
NH-8
AUGUST 21