COMMUNITY CARE LICENSING APPLICATION FOR …

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STATE OF california - HEALTH AND HUMAN services AGENCYCALIFORNIA department OF social SERVICESCOMMUNITY care LICENSINGAPPLICATION FOR A FAMILY CHILD care HOME LICENSEType or print clearly. USE ONLYNUMBER:TYPE:TYPE OF LICENSE:LICENSE #: LICENSING AGENCY:ADDRESS:PHONE:PHONE:CITYSTATEZIPC ITYCOUNTYSTATEZIPCITY STATE ZIPDATE LICENSED/CERTIFIED:ASSIGN:APPLICANT(S) FirstMiddleFirst NameMiddleApplicant(s) SignaturesCity and County where SignedDateLast NameRelationship to YouLast NameOver 18 Years Old? TYPE OF APPLICATION New APPLICATION Capacity Change Location Change Update6.

state of california - health and human services agency california department of social services community care licensing application for a family child care home license

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