NECPA Award Extension Request Form

The NECPA Commission offers currently accredited programs the opportunity to request an extension of accreditation. All requests are reviewed by the NECPA Extension Request Committee on a case-by-case basis and there is no guarantee that a request will be granted. Programs may be required to expedite their Verification Visit Request and/or National Accreditation Council Review.

"*" indicates required fields

The program must put in writing the reason(s) for the extension request and the length of extension requested.

The NECPA Office must receive this request prior to a program's accreditation expiration.
The corresponding forms and fees must be submitted before an extension request will be reviewed:

Non re-enrolled programs must submit their enrollment application, verification request and corresponding fees. The program will incur a monthly extension fee if the extension is granted.
Programs currently “Deferred with a Revisit” must submit their re-verification visit request and fee, and will incur a monthly extension fee if the extension is granted.
Programs in the following categories will incur a monthly extension fee if the extension is granted:
1. Programs that have submitted their verification request and are awaiting a visit;
2. Programs that have had their verification visit and are awaiting their determination;
3. Programs currently “Pending” or “Deferred with Items.”

Program Contact Information

NECPA Site Number*

Program Name*

Street Address*

Street Address Address Line 2 City State ZIP Code

Is this also your shipping address?*

Yes

Shipping Address*

Street Address Address Line 2 City State ZIP Code

Director*

First Last

Program Email Address*

Phone Number*

Program Renewal Information

Accreditation Expiration Date*

What day does your current award expire?

Re-Enrollment Date*

What day did your program re-enroll?

Verification Request Date*

What day did your program submit your visit request form?

Scheduled Verification Date (if applicable)

What day is your program's visit? (If visit scheduling is in process, skip this question.)

Deferral Re-Verification Request Date (if applicable)

What day did your program submit your visit request form? (If this step not applicable, skip this question.)

Deferral Re-Verification Date (if applicable)

What day is your program's re-visit? (If deferral visit scheduling is in process, skip this question.)

Reason for Extension*

Please write the reason(s) for the extension request in the space provided. Include as much detail as possible.

Supporting Documentation (Optional)

If you would like to provide additional documentation to support your request, please upload it here as a single file. Your upload may not exceed 5 MB.

Max. file size: 5 MB.

Length of Extension Requested in Months*

Please enter the number of months of extension requested, from 1 to 6. Extensions may not exceed 6 months.

Please enter a number from 1 to 6.

Understandings and Agreements

I have submitted all necessary request forms and fees prior to or with this request.
I understand that extension requests are reviewed by the NECPA Extension Request Committee on a case-by-case basis and there is no guarantee that an extension will be granted.
I understand that the program will be notified by written correspondence within 30 days of the submission of an extension request.
I understand that if granted, the program may be required to submit one or both of the following forms and applicable fees: 1) Expedited Verification Visit Request Form; 2) Expedited National Accreditation Council Results Request Form.
I understand that once the program has received full accreditation, The NECPA Commission reserves the right to incorporate any time granted for an extension into the program’s three year accreditation award period.

Please sign below to confirm you have read and will abide by the 'Understandings and Agreements' above.*

Please also print your full name below to confirm you have read and will abide by the 'Understandings and Agreements' above.*

Comments

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