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The form specifies completion fields for the AIT’s name, report dates, facility, instruction and work hours, plus preceptor and department head certification sections. Submission is required to reach the Board’s Office within 10 days after the reporting period end, supporting accurate, verifiable tracking of learning and progress.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/administrator-in-training-weekly-report-and-log-of-experience/253320/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/administrator-in-training-weekly-report-and-log-of-experience/253320.png","ImageObject",442,249,{"name":88,"@type":89},"Finn","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-09-13",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",8,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What must the Administrator-in-Training include in the weekly report?","Question",{"text":109,"@type":110},"Include department assignments with time spent, a summary of learning experience and observed problems, meetings/tours/visits, academic programs and reading materials, surveys and outcomes, and a summary of the weekly AIT experience with any improvements.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What information does the AIT need to fill out on the form?",{"text":114,"@type":110},"The AIT must provide name, report date, facility, the covered date range, and report the one-on-one instruction hours per week and total work hours per week, then certify that the information is true and accurate with a signature.",{"name":116,"@type":107,"acceptedAnswer":117},"Who certifies the training hours and instruction time, and what comments are required?",{"text":118,"@type":110},"The department head certifies that training was provided as outlined, and the preceptor certifies that the supervised AIT received the training and completed the indicated hours. Preceptors are also instructed to add comments about the AIT program on the back of the form.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},253320,1789265327,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":126,"read_time":4},34359740700684,"https://ap-avatar.wpscdn.com/avatar/1f400023980c374ae676?_k=1777273430885731487","ADMINISTRATOR-IN-TRAINING  \nWEEKLY REPORT AND LOG OF EXPERIENCE  REPORT \\#   \nThis is a cover sheet for your weekly report. Please attach your report. This report must be received in the Board's Office within 10 days of the end of the reporting period as outlined in Subchapter 37 D of the Rules and Statutes.  \nAIT Reports should be used to list experiences gained during the training period. It is recommended that you keep a daily record of your training experiences to facilitate preparation of your training report.  \nReports should be mailed to NC State Board of Examiners for Nursing Home Administrators  \n3733 National Drive, Suite 110  \nRaleigh, NC 27612  \nTO BE COMPLETED BY THE AIT:  \nNAME OF AIT:   DATE OF REPORT:    \nFACILITY:    \nDATES COVERED BY THIS REPORT FROM:   TO   During this period I received   Hours per week of one on one instruction from my Preceptor.  \nDuring this period I worked   Hours per week.  \nI certify, to the best of my knowledge, that the information presented is true and accurate. Signature of AIT    \nPlease include the following in your report:  \n􀁸 List assignments in departments with times spent in each  \n􀁸 Summary of your learning experience and any problems that you observed  \n􀁸 List meetings, tours, or visits you were involved with  \n􀁸 Discuss Academic Programs attended and Reading Materials  \n􀁸 Include Surveys and their outcomes you were involved with  \n􀁸 Summarize your weekly AIT experience and if any improvements could be made TO BE COMPLETED BY THE DEPARTMENT HEAD  \nI hereby certify that I trained the above named AIT in the area outlined in this report.  \nSignature of Department Head Date  \nTO BE COMPLETED BY THE PRECEPTOR  \nI certify that the AIT under my supervision has received the training described within this report and has completed the hours of training and worked the time indicated above. I also have given   Hours per week of one on one instruction during the report period.  \nSignature of Preceptor Date  \n**Preceptors please make comments about the AIT program on the back of this form**","cbCaiiHcV6Jnrlw4","https://ap.wps.com/l/cbCaiiHcV6Jnrlw4","pdf",24296,"English","# TO BE COMPLETED BY THE AIT\n## NAME OF AIT\n## DATE OF REPORT\n## FACILITY AND REPORT DATES\n## INSTRUCTION AND WORK HOURS\n## CERTIFICATION AND SIGNATURE\n# TO BE COMPLETED BY THE DEPARTMENT HEAD\n## DEPARTMENT HEAD CERTIFICATION\n## SIGNATURE AND DATE\n# TO BE COMPLETED BY THE PRECEPTOR\n## PRECEPTOR CERTIFICATION\n## SIGNATURE AND DATE\n# PRECEPTOR COMMENTS","[{\"question\":\"What must the Administrator-in-Training include in the weekly report?\",\"answer\":\"Include department assignments with time spent, a summary of learning experience and observed problems, meetings/tours/visits, academic programs and reading materials, surveys and outcomes, and a summary of the weekly AIT experience with any improvements.\"},{\"question\":\"What information does the AIT need to fill out on the form?\",\"answer\":\"The AIT must provide name, report date, facility, the covered date range, and report the one-on-one instruction hours per week and total work hours per week, then certify that the information is true and accurate with a signature.\"},{\"question\":\"Who certifies the training hours and instruction time, and what comments are required?\",\"answer\":\"The department head certifies that training was provided as outlined, and the preceptor certifies that the supervised AIT received the training and completed the indicated hours. Preceptors are also instructed to add comments about the AIT program on the back of the form.\"}]","Administrator-in-Training Weekly Report and Log of Experience | PDF"]