Application Process

  • Title:  Initial Application Form
    About: This form is used for an organization, not previously licensed by the Department, to apply to provide behavioral health care services (substance abuse and/or mental health) to adults and substance abuse services to minors. This initial form needs to be submitted only once. The (twelve) licensed services can be chosen from the menu on page 2 (Part III Selected Services Information).

  • Title:  Renewal or Add Services/Site Application Form
    About: This form is used by Behavioral Healthcare Organizations to: Renew an existing license, add a licensed service/program at an existing site, add a new site for licensed service delivery. Licenses are required to be renewed every two years. An Add Service or Site application may be submitted at any time.

  • Title: Application for Initial Licensure to provide services to Adults with Developmental Disabilities
    WORD Version
    About: This form is used by an organization, not previously licensed by the Department, to apply to become a Developmental Disability Organization which can provide services to adults with developmental disabilities. This initial form needs to be submitted only once.

  • Title:Application for Licensure Renewal to provide services to Adults with Developmental Disabilities OR Application to add a Service or add a Site
    WORD Version
    About: This form is used by Developmental Disability Organizations to renew an existing license, add a licensed service/program at an existing site, and/or add a new site for licensed service delivery. An "Add Service" or "Add Site" application may be submitted at any time. Licenses are required to be renewed every two years. Renewal applications must be submitted prior to the expiration date identified on a current license.

  • Title: FEIN Addendum
    About: The Department is required to obtain this information. It is to be submitted with each license renewal application. It is not required with an Add Service/Site application.