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APPLICATION

Please note: The following downloads are available in Adobe Acrobat (version 6.0) file format. This file format is read-only and print-only (not editable). You will need the Adobe Acrobat Reader to download these files. The Acrobat Reader is available FREE OF CHARGE at Adobe's website. THIS LINK will take you to Adobe's site. Follow the instructions there for downloading the Acrobat Reader.

 

 

New Applications For Placement on the Approved Provider List -- revised July 18, 2007
These applications are for individuals who want to be placed on the Approved Provider List.
(To review the Provider Qualifications for these applications, please refer to Section 9.0 of the Standards.

NEW FEE POLICY EFFECTIVE JULY 1, 2008

(All application fees are non-refundable.)

 
Application for Entry Level (see Section 9.01 of the Standards)
 
Application for Provisional Level (see Section 9.07 of the Standards)
 

PLEASE NOTE: The Application for Provisional Level is for rare and unusual circumstances. The decision to grant provisional approval will be primarily based upon a well documented community need which shows that certain community needs cannot be met by existing providers who currently meet the Standards For Treatment With Court Ordered Domestic Violence Offenders.
 
Application for Full Operating Level (see Section 9.02 of the Standards)
 
Application for DV Clinical Supervisor Level (see Section 9.03 of the Standards)

Specific Offender Population Application (see Section 10.0 of the Standards)
PLEASE NOTE: This additional application is to request approval to treat a specific offender population (such as female or gay or lesbian offenders).

 

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