Instructions For Requesting A Variance Or Exception To Regulation Page 3
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4CHILD DEVELOPMENT DIVISION
Child Care Licensing Unit
REQUEST FOR VARIANCE FORM
Your Name:
Name of Program or Facility:
Certificate Number:
Address:
Daytime Telephone:
E-mail:
I am requesting a variance from the following regulation or requirement
:
Legally Exempt Child Care
Section ____________Number ____________.
Family Day Care Homes
Section ____________Number ____________.
Early Childhood Program
Section ____________Number ____________.
School Age Program
Section ____________Number ____________.
Licensed Family Child Care Home
Section ____________Number ____________.
Non-Recurring Care
Section ____________Number ____________.
Use additional pages to answer these questions if you do not have enough room.
Remember, the burden is on you to make the case for a variance. Be complete and
thorough in your answers.
Please send all completed forms to:
Child Development Division
Variance Requests
103 South Main Street 2 North
Waterbury, VT 05671-2901
1-802-241-3110 or 1-800-649-2642
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