ADHS Division of Licensing Services

Assisted Living Facilities License Application Forms

Notice Regarding Application Fees:

A.R.S. § 36-405(C)(1) requires the Department to collect nonrefundable application fees from all health care institutions. All Initial, Renewal, and Change of Ownership applications must include a $50 nonrefundable application fee. The Department will consider any application received without the application fee to be incomplete.  (Note: This does not apply to Child Care Licensing.) Checks shall be made payable to the Arizona Department of Health Services.

NOTE: All applications require an Arizona Statement of Citizenship and Alien Status.

• Initial License Application Packet
  • Initial Application Form, including Instructions, Remittance Form and Supplement
  • Letter of Compliance, Zoning, Fire & Floor Plan for Initial Application
• Renewal License Application Packet
• Architectural Review Application
• Survey Tool
• Initial Survey Checklist
• Credit Card Payment Form and Instructions
• Training Program Initial Application
• Training Program Renewal Application

For a Change of Ownership Application, please contact the Office of Assisted Living by phone or in writing.

Information provided in PDF files, unless otherwise indicated.