Get Form 21sc

Filling out the Form 21sc is an important step for individuals seeking to apply as a provider for early intensive behavior intervention in South Carolina. This guide offers straightforward, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to successfully complete the Form 21sc online.

1. Press the ‘Get Form’ button to download the form and open it in your preferred online editor.
2. Begin by entering your name in the designated field at the top of the form. Make sure to use the full legal name as it appears on official documents.
3. In the 'Organization' field, provide the full name of your organization or the entity you represent, if applicable.
4. Complete the address section with your current residential or business address. Ensure that all components are correctly filled, including street, city, state, and zip code.
5. Fill in your contact information, including your phone number, fax number (if available), and email address to ensure reliable communication.
6. Indicate your area of provider qualification by noting your highest degree earned, the year it was obtained, the name of the school, and your major field of study.
7. If relevant, provide your BABC level and certification number, along with the number of years of your professional experience in the field.
8. Use the space provided to describe your type of experience. Select either independent practitioner or supervised clinician and briefly elaborate on your applicable experience.
9. Describe your current responsibilities, including your job title and the classification of individuals you serve in this role.
10. In the programming approach section, detail your methodological approach and the behavioral principles that apply to your programs, ensuring clarity and specificity.
11. Answer the question regarding previous criminal convictions accurately. If applicable, list the charges, location, date, and current status of the conviction.
12. Attach the required documents, including a current curriculum vitae, educational or behavioral testing evaluation, a program example, and a behavioral support plan.
13. Sign and date the form to certify that all information provided is true and accurate. Your signature affirms your agreement to the terms outlined.
14. Once you have completed the form and attached all necessary documents, save your changes. You can then download or print the completed form.
15. If needed, share the completed form through the appropriate channels outlined in the form's submission instructions.

Complete your Form 21sc online today to enhance your application process.