Application For A Child Care Center License Form - Dhhs Page 7
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7REQUIRED ADDITIONAL DOCUMENTATION
Applications for a Child Care Center License
Provisional Application: The following additional documents and forms must be submitted
with your provisional application:
1. A “Consent and Authorization for Release of Information” must be included for:
Applicant(s) (see page 4 of the Application for definition of applicant)
Director
2. Agreement for Prior to Hire Registry Checks.
3. Documentation of criminal history record checks for the following individuals: 1) an individual owner, 2)
individuals in a partnership, 3) the individual who will be the director of the center if applicant is a limited
liability company or a corporation (See 391 NAC 3-006.03A), and 4) if the center is to be located in a private
residence, all staff, volunteers, and all household members age 19 and older.
4. A Report of Law Enforcement Contact for the following individuals: 1) applicant, 2) the individual who will
be the director of the center if the applicant is a limited liability company or corporation (See 391 NAC 3-
006.03C), and 3) if the center is to be located in a private residence, all staff, volunteers, and all household
members age 19 and older.
5. A Health Information Report for the director (See 391 NAC 3-006.03F).
6. Documentation of director qualifications or a written plan that has been approved by the Nebraska
Department of Education (See 391 NAC 3-006.04).
7. Documentation of completed Director Orientation (“Director Orientation Review: Statements of
Understanding”)
8. A sketch, diagram, or blueprint of the facility showing the dimensions, arrangement of rooms to be used by
children and outdoor play area.
9. Copy of zoning approval from the relevant jurisdiction.
10. Proof of Liability Insurance. ***
11. The required Licensing Fee (See 391 NAC 3-004.08).
***Proof of Liability Insurance MUST be submitted prior to a license being issued if not submitted with your
application.
Operating Application: The following additional documents and forms must be submitted
with your operating application:
1. A Report of Law Enforcement Contact for the following individuals: 1) applicant, 2) the individual who will
be the director of the center if the applicant is a limited liability company or corporation (See 391 NAC 3-
006.03C) and 3) if the center is to be located in a private residence, all staff, volunteers, and all household
members age 19 and older.
2. Proof of Liability Insurance.
3.
The required Licensing Fee (See 391 NAC 3-004.08).
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