Edit, Download, and Sign the Michigan CDC License Exempt Provider Application

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How do I fill this out?

To fill out this application, start by identifying your provider type. Gather the necessary identification and address verifications. Complete each section accurately before submitting your application.

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How to fill out the Michigan CDC License Exempt Provider Application?

  1. 1

    Determine your provider type: License Exempt-Related or Unrelated.

  2. 2

    Collect your identification and address verification documents.

  3. 3

    Fill out all required sections of the application form.

  4. 4

    Submit the completed application along with required documents.

  5. 5

    Await confirmation and details about the next steps via email or phone.

Who needs the Michigan CDC License Exempt Provider Application?

  1. 1

    Individuals wanting to provide child care services for relatives.

  2. 2

    Adults seeking to offer child care without full licensing requirements.

  3. 3

    Parents needing care for their children at home.

  4. 4

    Caregivers looking to comply with state regulations.

  5. 5

    People interested in working with the Michigan Department of Education.

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What are the instructions for submitting this form?

To submit this form, send the completed application along with required verification documents to Child Development and Care Program, Provider Enrollment, P.O. Box 30267, Lansing, MI 48909. Alternatively, you may fax your documents to 517-284-7529 or email them to MDE-ApplyProvider@michigan.gov. Ensure that all documents are complete and accurate to avoid delays.

What are the important dates for this form in 2024 and 2025?

Check for updates related to training requirements and application submission deadlines during 2024 and 2025. Ensure all verifications are submitted on time to avoid delays in processing your application. Note that trainings must be completed annually.

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What is the purpose of this form?

The purpose of the License Exempt Provider Application is to officially enroll individuals in the State of Michigan's child care program. It outlines the necessary requirements and steps for becoming a license exempt child care provider. This form helps ensure that caregivers meet the necessary standards for providing child care in a safe and regulated environment.

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Tell me about this form and its components and fields line-by-line.

The form consists of various components that collect personal and professional information relevant to the applicant's eligibility as a child care provider.
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  • 1. First Name: The applicant's first name.
  • 2. Last Name: The applicant's last name.
  • 3. Date of Birth: The applicant's date of birth.
  • 4. Driver License/ID Number: The identification number for the applicant's driver's license or state ID.
  • 5. Email Address: The applicant's email for communication.
  • 6. Telephone Number: The applicant's contact number.
  • 7. Social Security Number: The applicant's social security number.

What happens if I fail to submit this form?

If you fail to submit this form, your application for child care provider status may be denied. Missing documents and incomplete information can hinder your ability to operate legally as a caregiver. It is crucial to follow all submission instructions to ensure compliance.

  • Incomplete Application: Not providing all requested information can lead to denial.
  • Missing Verification Documents: Failure to submit necessary documents may cause delays or rejection.
  • Failure to Pass Background Check: Inability to pass background checks could result in denial of application.

How do I know when to use this form?

Use this form when you wish to become a License Exempt Provider in Michigan, either related or unrelated to the child. It is essential for those aiming to provide child care without acquiring a full provider license. Filling out this application is the first step in legally offering care.
fields
  • 1. Related Providers: Use this form if you are related to the child and seeking to provide care.
  • 2. Unrelated Providers: Required for individuals not related but wanting to care for children in the child's home.
  • 3. New Caregivers: Ideal for new caregivers entering the child care sector.

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