Get Change Of Director Notification Form - Arizona Department Of Health ...

Filling out the Change Of Director Notification Form is essential for updating the Arizona Department of Health Services about changes in facility directors. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to successfully complete your form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin with the section labeled 'Name of Director'. Input the full name of the new facility director. Ensure that the name is spelled correctly as it will be used in official records.
3. Fill in the 'Start Date as Director' field with the date the new director will officially begin their role. Use the format requested by the form, typically MM/DD/YYYY.
4. Enter the 'Certificate #' if applicable. This is usually assigned by the Arizona Department of Health Services and may relate to the current licensure of the child care facility.
5. Provide the 'CDC Facility Name'. This should match the name registered with the Arizona Department of Health Services.
6. Complete the 'Facility Address' section, including street address, city, and zip code. This information helps the department identify the specific facility in question.
7. Input the 'Facility Telephone #' to ensure the department can reach the facility if further clarification is needed.
8. Confirm that the new director meets the age requirement (at least 21 years) and understand their primary responsibilities. Collect and prepare documentation that supports their qualifications in the fields outlined in the form.
9. Review the qualifications section regarding academic experience. Ensure that the new director's qualifications align with the requirements stated and that documentation is available on-site.
10. Check the section for qualifying child care experience. List the necessary documentation that demonstrates the new director’s qualifying experience. Ensure this information is accurate and readily available.
11. Once all fields are accurately completed, verify your information to prevent errors. After confirmation, you can save your changes, download, print, or share the completed form as needed.

Complete your Change Of Director Notification Form online today to ensure timely updates to your facility's records.