NECPA Enrollment Form - ELCOC

Program Name*

Street Address*

Street Address Address Line 2 City State ZIP Code

Is this also your shipping address?*

Yes
No

Shipping Address*

Street Address Address Line 2 City State ZIP Code

Director*

First Last

Program Email Address*

Phone Number*

Fax Number (If applicable)

Owner Name*

Is Your Program Center-Based or Home-Based?*

Center-Based
Home-Based

Are you a multi-site family home provider?*

Yes
No

NECPA MULTI-SITE FAMILY CHILD CARE PROVIDER POLICY
1. One program Director must facilitate the operations of the program as a whole.
2. The sites must be within “walking-distance” to one another so that the Director is able to access each site daily and at a moment's notice.

Alternate Contact Name*

Alternate Contact Phone Number*

State License or Registration Number*

Please Upload a Copy of Your State License*

Accepted file types: jpg, gif, png, xlsx, xlx, csv, pdf, Max. file size: 50 MB.

Multi-Site Provider - Secondary License Upload

Accepted file types: jpg, gif, png, xlsx, xlx, csv, pdf, Max. file size: 50 MB.

Please upload your second location's license here.

License Capacity*

This must match your noted state license capacity. If your program utilizes more than one license, please total the capacities.

Number of Classrooms*

Number of Buildings*

What ELCOC Cohort are you in?*

NECPA Process Understandings

1) I understand that the NECPA accreditation is valid for three years with the submission of an Annual Report during each of the accreditation years.
2) I understand that a NECPA Accredited program is required to maintain NECPA standards, requirements and physical plant under which the program is awarded accreditation.
3) I understand that the NECPA Commission reserves the right to revoke the accreditation of any program found to be out of compliance with the NECPA standards.
4) I understand that the enrollment period lasts for two years from the date of the NECPA Enrollment Letter issued by the NECPA Office and that the NECPA Verification Visit Request Form must be submitted within that time period.

Please print your full name to agree to the above NECPA Process Understandings*

Phone

This field is for validation purposes and should be left unchanged.