hrla: Application Package
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Assisted Living Residence
 
The Assisted Living Residence (ALR) Program application must be completed and contain all documents listed below. The ALR staff reviews all documents and forms and determine if the requirements are met for survey and ultimately licensure. Please follow the instructions for each and include all forms in the application in hard copy format.
  • Printable Forms: Print the form, fill it out, sign it, and include it with the application package.
    Specific instructions are provided within each form below.
 
Application Information Documents
Assisted Living Residence - Application Instructions*
Certification--Clean Hands Act*
Initial/Annual Renewal Licensure-Survey Instructions and Documents*
Insurance Notice of Final Rulemaking*
Voluntary Transfer, Discharge, and Relocation Document*
 


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