NECPA Expedited Scheduling Form

This form is to be used by programs that have an ACTIVE Verification Visit Request. If you have not submitted the Visit Request Form, please submit the NECPA Verification Visit Request Form. You will have the option to expedited scheduling using the visit request form.

The purpose of this form is to notify the NECPA Commission that your program would like to expedite the scheduling of your EXISTING verification visit, reducing your scheduling window from 120 days to 60 days from the date of your request.

Program Name*

NECPA Site Number (8-Digits)*

Program Director Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email Address*

Expedited Verification Visit Request Fee*

Price:

Would you also like to expedite your program's results?

Yes
No

Expediting this process will shorten your Council Review and Result timeline to two weeks from the day your visit materials are received at the NECPA Office. Results are issued 8 weeks from the day of the visit if not expedited.

Expedited Results Fee

Price:

Receive your results within 2 weeks of your visit materials arriving at the NECPA Office.

Agreements

1) I have answered each question in the yellow and blue sections of the Self Assessment Instrument or given a written explanation in the comment section if the question is not applicable to my program.
2) I have collected surveys from at least 70% of my full and part time staff and 50% of the families we serve.
3) In the event that I place my program’s verification status on hold, any changes to NECPA standards and fees will be applicable to the program at the time of reactivation of the verification visit request.
4) I understand that my visit will be scheduled within 60 days once the NECPA office receives this form and payment in full.
5)I understand that program cancellations, changes to block out dates, requests to place program on hold, and/or refusal of visit dates are subject to additional fees.

I confirm my program has an active Verification Visit Request and with this form I am expediting the current visit scheduling timeframe to 60 days from this submission. I understand expedited requests are only processed for programs with an active Verification Visit Request.*

Yes, I have an active Verification Visit.

If your program DOES NOT have an active Verification Visit Request, please complete the Verification Visit Request Form, and select the option to expedite scheduling.

PLEASE DO NOT SUBMIT THIS FORM WITHOUT AN ACTIVE VERIFICATION VISIT REQUEST.

Please Print Your Name To Agree To The Stipulations*

Payment Details

Fees are non-refundable and subject to change without prior notice.

Total Amount

$0.00

Credit Card

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Card Number Expiration Date Security Code Cardholder Name