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Community Residence Facilities - Application Package
The Community Residence Facilities licensure application must be completed and contain all documents listed below. The staff reviews all documents and forms and determine if the requirements are met for survey and ultimately licensure. Please follow the instructions for each and include all forms in the application in hard copy format.
Printable Forms: Print the form, fill it out, sign it, and include it with the application package. Specific instructions are provided within each form below.
Application Package Documents
- License Application [PDF]
- Clean Hands Certification [PDF]
- Disclosure of Ownership and Control Interest Statement [PDF]
- Insurance Verification Request [PDF]
- Fire Inspection Letter [PDF]
- Voluntary Transfer Discharge and Relocation Document [PDF]