Follow the steps to successfully complete the waiver request form.

1. Press the ‘Get Form’ button to access the AZ Better Chance Child Waiver Request online and open it in your preferred editor.
2. Fill in the agency information at the top of the form, including the agency name, site name, facility number, address, city, ZIP code, and phone numbers. This information helps identify the submitting agency.
3. Provide the name and email of the ABC coordinator. This is important for communication regarding the waiver request.
4. In the important waiver information section, familiarize yourself with the stipulations. Remember that each waiver will be reviewed on a case-by-case basis and that supportive documents are required.
5. Complete the child information section. Enter the child's name, date of birth, and the reason for the waiver request. Ensure that the reason is clear and well-articulated to support your request.
6. Gather and attach all necessary documentation. This includes the child’s birth record, documentation of income, proof that all eligible children are served, and any supporting documents for developmental delays or at-risk factors.
7. Submit the completed waiver request electronically. Send it via email to CopaSupport.MailAccount@dhs.arkansas.gov, ensuring you use the subject line format: 'Agency Name' 'Site Name' Child Waiver Request'. Confirm that all attachments are included before sending.
8. After submission, keep a copy of the completed form and sent email for your records. Monitor for a written determination from the DCCECE regarding your request.

Complete your documents online today to ensure a smooth waiver request process.