Application For A Preschool License - Nebraska Dhhs/division Of Public Health
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7INSTRUCTIONS
Application for a Preschool License
PROGRAM INFORMATION
1. Type of License: Indicate whether you are applying for a Provisional License (first year of licensure) or are
applying for a Non-Expiring Operating License (you must have first completed one year under a provisional
license.
2. Name of Preschool: The name of your preschool which will appear on your license.
3. Physical Address of Preschool: The physical address where the preschool is operated
4. Type of Structure: Indicate whether the program is located in a church, school or other structure such as a
store front, government building, etc.
5. Phone/Fax Number of Preschool: The phone number with the area code for the preschool. You are required
to have an operating phone on the premises. A cell phone is acceptable. A fax number is requested, if available.
6. Email Address of Preschool: The email address of the preschool, where correspondence from the Department
of Health and Human Services can be sent.
7. Name of Preschool Director: The name of the individual who will responsible for the day to day operation of
the preschool program including compliance with all regulations.
8. Requested Licensed Capacity: Refer to the Preschool Regulations to determine the capacity of your preschool.
The capacity you request may not be approved by DHHS and/or the Fire Marshal. The number of children in
care cannot exceed the licensed capacity at any time.
9. Age Range of Children to be Served by the Program: Refer to the Preschool Regulations to determine what
age range of children you may serve.
10. Hours of Operation: The hours that preschool services will be provided.
11. Days of Operation: Check each day of the week you will be operating your preschool.
12. Preferred Mailing Address: The address where all mail from the Department of Health and Human Services
should be sent. Include Street, P.O. Box (if applicable), city, state, & zip code.
13. Will the Preschool be located in a Private Residence? When the Preschool will NOT be located in the
applicant’s residence check the NO box and proceed to page 2 of the application. When the Preschool WILL
be located in the applicant’s residence check the YES box. You must then provide the required information for
ALL persons residing in the household.
NOTE: Applicant must submit zoning approval from relevant
jurisdiction to the Department of Health and Human Services to meet licensing requirements--- Refer to
document “Additional Documentation Required.”
Instructions continue on next page→→→→→
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