Follow the steps to complete the application effectively.

1. Click the ‘Get Form’ button to access the document and open it in the editor.
2. Select the application type by indicating whether it is an initial application or a renewal. Specify the population the facility will serve: children/adolescents or adults. If renewing, enter the license number.
3. Provide the residential facility information, including the facility name, phone number, street address, city, zip code, county, and fax number.
4. Fill in the mailing address for official correspondence. You can choose to mail to the facility address or the owner/operator address.
5. Enter the emergency contact information, ensuring that you provide a number different from the facility phone number. Include the names of the owner/operator and the manager, along with their respective emergency phone numbers.
6. Indicate the ownership or organization structure of the facility by selecting the appropriate category (e.g., non-profit corporation, for-profit corporation).
7. Complete sections regarding the owner/operator information, including names, titles, addresses, phone numbers, and email addresses for all responsible parties.
8. Attach a document labeled 'Attachment One: Organization Information' with details about the Board of Directors or Corporate Officers as required.
9. Answer questions related to any affiliations with previously licensed residential facilities, and provide any requested details regarding those affiliations.
10. Submit the required property owner information, providing details about the owner or confirming that the business owner is the same as the property owner.
11. Fill out the requested license capacity information, including details on the maximum number of licensed beds and household members.
12. Complete the occupancy information section, providing current counts of residents, including those with mental illness and special considerations for non-ambulatory residents.
13. Respond to the owner/manager questions, checking 'same' if the manager is the same as the owner, or answering each question as applicable.
14. Provide details regarding the facility space and the lavatory/bathing facilities ensuring compliance with the necessary requirements.
15. Include a comprehensive list of required inspections or licenses relevant to your application.
16. Answer supplemental questions and provide any additional documentation required by the form.
17. If applicable, complete the attestation section by signing and dating the application. Ensure that all signatures required for your operation structure are included.
18. Review your application for completeness before submitting it along with the attached documents and application fee.

Start filling out your application for residential licensure online today!