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The
application contains five (5) sections:
Section 1 contains
general information about the organization and the
services provided.
Section 2 asks for
information to be submitted with the application.
Section 3 requests
information about the types of services, supports
provided by the organization and about people receiving
services.
Section 4 contains
information about the people served.
Section 5 requires a
signature from the organization regarding the conditions
related to the on-site
quality
review
The application is available
to download in both Microsoft Word and Adobe Reader
formats. An Excel file is also available for use
in submitting the roster of people the organization
provides services to.
Application
in Microsoft Word format.
Application
in Adobe Reader (pdf) format.
Excel Roster
File |
