Follow the steps to complete the LA CCL 25R form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Select the type of license you are applying for by checking the appropriate box for either an initial application or renewal application, as well as any changes related to ownership or location.
3. Provide the facility information. Include the facility name, location address (street, city, state, and zip code), mailing address, facility telephone number, office telephone number, and e-mail address. Be sure to enter the parish and facility website address if applicable.
4. Indicate the organizational structure by selecting one box for individual, partnership, church, university, corporation/LLC, or governmental entity. Fill out the corresponding fields for the selected structure, including names, addresses, dates of birth, federal EIN, and state tax ID numbers.
5. Attach documentation for satisfactory criminal background checks and state central registry disclosure forms as required for all owners and directors/administrators. Ensure that all listed individuals meet the requirements.
6. Complete the program information section by selecting the type of facility you aim to operate (child residential facility, maternity home, juvenile detention, or child placing agency) and providing all necessary details, such as licensed capacity and age range of the clients served.
7. If applicable, specify each physical location for transitional placing services. Include the age ranges served and capacity for each location.
8. Fill in the details of the facility director/administrator, ensuring qualifications are met, and include personal character references as required.
9. Check the applicable funding sources for your facility and provide any additional explanations if needed.
10. Complete the declaration statements section, certifying that the application information is true and correct. Provide your signature and date.
11. Once all sections have been filled out correctly, save your changes. You may then download, print, or share the completed form as needed.

Start filling out your LA CCL 25R form online today to ensure compliance with licensing requirements.