Licensed Provider Application

Once a parent/guardian whose child(ren) is determined eligible for assistance from our program and they request you care for that child(ren) in your home or center, you will receive the following documents to complete and return to our office:

1.    Application for Licensed Provider
2.    Contract
3.    Caregiver/Provider Agreement
4.    Submit copy of your State license from DHS
5.    W-9 form

Pending Provider Applications

An incomplete application will be placed in a pending file until all required documents are received by our office.  A Pending Notice will be mailed to the provider and to the parents to notify that no day care payments will be made by our office during the provider’s pending status.  If, after 30 days, the pending application packet is not complete, the provider and parents will be notified that day care assistance will not be provided.