Get Application For Approval Of Familychosen Provider Provider ...

Filling out the Application for Approval of Family-Chosen Provider is an essential process for families seeking to select and approve a respite provider. This guide provides clear, step-by-step instructions to assist you in completing the form online, ensuring a smooth and efficient submission.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to access the application and open it for editing.
2. Select either 'Private Respite Provider (PP)' or 'Counseling, Training and Education (CTE)' by checking the appropriate option. Remember that only one option can be selected.
3. In the 'Provider Information' section, provide all applicable details clearly. This includes the family name requesting the provider, the name of the family-selected provider, and if necessary, the signature of a parent or guardian.
4. Indicate the type of service provided and describe past experience in delivering this service. Include any certifications or training of the personnel.
5. Fill in the provider's hourly or quarterly charge in the designated field.
6. Review the entire form to ensure that all applicable information is completed, signatures are included, and that either a private provider or CTE provider has been correctly marked.

Complete the application online now to ensure timely processing and approval of your family-chosen provider.