NECPA Verification Visit Request - Pre-Paid Via Invoice

Request Form Purpose

The purpose of this form is to notify the NECPA Commission that your program has completed the self-study portion of the NECPA accreditation process and that you are ready to begin scheduling your verification visit. PLEASE SUBMIT THIS FORM TO SCHEDULE A VERIFICATION VISIT. You may only submit this form if you have recently pre-paid using an invoice.

Required Reading to Submit a Visit Request: Verification Visit Scheduling Process

Program Name*

NECPA Site Number (8-Digits)*

Program Director Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email Address*

State License or Registration Number*

Licensed Capacity*

Number of Classrooms*

Number of Buildings*

Would your program be willing to allow the NECPA to use your verification visit as a training opportunity for NECPA Verifiers?*

Yes
No

Days of Operation*

Select All
Monday
Tuesday
Wednesday
Thursday
Friday

Check all that apply

Hours of Operation*

Is your program enrolled with Paths to QUALITY?*

Yes
No

By participating in accreditation, you MAY be eligible for Accreditation Financial Assistance through the Indiana Accreditation Project (IAP). You must be enrolled with Paths to QUALITY to be eligible to apply for IAP support. Learn more about Paths to Quality here https://indianaspark.com/paths-to-quality.

Is your program enrolled with the Indiana Accreditation Project (IAP)?*

Yes
No

Learn more about the IAP program here: https://inaeyc.org/indiana-accreditation-project.

Five Block Out Dates

*Block out dates are any days that your program would not be available for a verification visit. You may have five block out days. Days must be listed above in order of preference. The NECPA Office is closed on all federal holidays and will not conduct verification visits on these days.

NECPA Process Understandings and Agreements

1) I have answered ALL questions in the yellow AND blue sections of the Self Assessment Instrument.
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 120 days (or 60 days if expedited) 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.
6) I have read the Verification Visit Scheduling Process document provided at the top of this form prior to submitting this request.

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

Paid Invoice Number*

Please include the invoice number for your paid verification visit invoice.

Indiana Accreditation Financial Assistance Understandings

I understand that in order to apply for Accreditation Financial Assistance with the INAEYC Indiana Accreditation Project (IAP), I must:
1) Be enrolled and in good standing with Paths to QUALITY™ at any level,
2) Submit to IAP through their online application, an open enrollment invoice from NECPA,
3) Submit my IAP scholarship application within 30 days of my NECPA enrollment submission.

I also understand that if my application for Accreditation Financial Assistance is denied for any reason, I will be responsible for the NECPA accreditation fees. Additionally, I understand that I am responsible to pay for any supplemental fees, such as additional block out dates and expedite fees, as these are not covered by the IAP scholarship program.

Please print your full name to agree to the Indiana Accreditation Financial Assistance Understandings*