Effective Date: 
6/2018

Documents

Instructions

Updated: 6/2018

Purpose

This form is used to assist child care providers to comply with minimum standards within a specified period of time, without compromising the safety of children served by the operation.

Procedure

When to Prepare

Providers can use this form when requesting to waive a minimum standard in specific instances. A waiver is appropriate when the economic impact of compliance is sufficiently great to make compliance impractical, or a variance if there is a good and just cause for the applicant or operation to meet the purpose of the standard in a different way.

Transmittal

A provider who applies for a waiver or variance can do so by submitting the request online through the Public and Provider page or by sending a completed Form 2937 to Licensing. In both instances, the provider must send any supporting documentation to Licensing, as needed.

Detailed Instructions

Complete all sections of the form that are relevant to the waiver or variance prior to submitting to Licensing.

Name of Operation ─ Enter the name of the operation that the request refers to.  If the request is for a registered child care home, independent foster family home or independent foster group home, enter the first and last name of the caregiver.

Operation No. ─ Enter the operation number.

Area Code and Telephone No. ─ Self-explanatory.

Street Address of Operation, City, County, ZIP Code and Email Address ─ Self-explanatory.

Name of Governing Body Representative, Area Code and Telephone No. ─ Enter the name of the person designated to represent the governing body.  If the request is for a licensed child care home, registered child care home,  independent foster family home, or independent foster group home, enter the caregiver’s name. Include the person’s area code and telephone number.

Address of Governing Body Representative, City, State and ZIP Code ─ Self-explanatory.

Information About Waiver/Variance, Questions 1 through 8 ─ Answer each question.

Name of Agency Foster Family Home or Agency Foster Group Home, Mailing Address of Home, Number of Children in Care, Ages, Specialized Home Yes or No, and Specific Type ─ Complete this information only if this request is for a child-placing agency.

Signature and Date Submitted ─ The document should be signed and dated by the person designated to represent the governing body, the licensed or registered caregiver, independent foster family home or independent foster group home caregiver.

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