Child Care Center, Preschool & Head Start

Application Packet Forms

  1. CCL 150 Regulations to Consider (PDF)
  2. CCL 301 App for a NEW CCC, PS or HS (PDF)
  3. CCL 301a Instructions CCC, PS, HS (PDF)
  4. CCL 301b Application Checklist CCC (PDF)
  5. CCL 301c Site Approval (PDF)
  6. CCL 302 Renewal Application CCC, PS, HS (PDF)
  7. CCL 303 Closure Notification (PDF)
  8. CCL 305 Immunization Report Form (PDF)
  9. CCL 306 Infant and Toddler Care CCC (PDF)
  10. CCL 310 Staff Training and Qualifications (PDF)
  11. CCL 311 Staff Qualifications Chart KAR 28-4-429(h) (PDF)
  12. CCL 312 Staff Qualifications Chart KAR 28-4-429 Program Director (PDF)
  13. CCL 401 Orientation Checklist for Child Care Center Preschool (PDF)
  14. CCL 002 Background and Registry Check (PDF)
  15. CCL 002 Background and Registry Check Spanish (PDF)
  16. CCL 002a CCC-PS-HS Affiliate Roles (PDF)
  17. CCL 002a CCC-PS-HS Affiliate Roles Spanish (PDF)
  18. CCL 028a Critical Incident Report (PDF)
  19. Critical Incident Reporting FAQs (PDF)
  20. Corrective Action Plan Provider Instructions (PDF)
  21. Corrective Action Plan Template (PDF)

Supplemental Forms in Application Packet

  1. CCL 002 Background and Registry Check (PDF)
  2. CCL 002 Background and Registry Check Spanish (PDF)
  3. CCL 002a CCC-PS-HS Affiliate Roles (PDF)
  4. CCL 002a CCC-PS-HS Affiliate Roles Spanish (PDF)
  5. CCL 005 Yearly Mechanical Safety Check (PDF)
  6. CCL 005 Yearly Mechanical Safety Check Spanish (PDF)
  7. CCL 009 Health Assessment, 16 and Older (PDF)
  8. CCL 009 Health Assessment, 16 and Older Spanish (PDF)
  9. CCL 010 Authorization for Emergency Medical Care (PDF)
  10. CCL 010 Authorization for Emergency Medical Care Spanish (PDF)
  11. CCL 026 Short-Term Medication Authorization (PDF)
  12. CCL 026 Short-Term Medication Authorization Spanish (PDF)
  13. CCL 027 Long-Term Medication Authorization (PDF)
  14. CCL 027 Long-Term Medication Authorization Spanish (PDF)
  15. CCL 029 and 029a Child Medical Record, Immunization History, and Health Assessment (PDF)
  16. CCL 029 and 029a Child Medical Record, Immunization History, and Health Assessment Spanish (PDF)
  17. CCL 034 Parental Permission, Off-Premise Trips (PDF)
  18. CCL 034 Parental Permission, Off-Premise Trips Spanish (PDF)
  19. CCL 035 Parental Permission, Off-Premise, Group Trips (PDF)
  20. CCL 035 Parental Permission, Off-Premise, Group Trips Spanish (PDF)
  21. CCL 203 Child Care Centers Self-Audit Survey Tool (PDF)
  22. CCL 203 Preschool Self-Audit Survey Tool (PDF)
  23. CCL 207 Record of Observations (PDF)
  24. CCL 307a Instructions for Completing CCL 307 (PDF)
  25. CCL 307 Application for Program Director Approval (PDF)

Supplemental Forms not in Application Packet

  1. CCL 031 Request for Exception (PDF)
  2. CCL 031 Request for Exception Spanish (PDF)
  3. CCL 032 Request for Amendment (PDF)
  4. CCL 032 Request for Amendment Spanish (PDF)
  5. CCL 209 Notification of Program Director Change (PDF)
  6. CCL 309 Inquiry Regarding Licensure CCC Mother's Day Out (PDF)

Informational Documents

  1. Child Care Initial and Annual Surveys (PDF)
  2. Child Care Initial and Annual Surveys Spanish (PDF)
  3. Child Care Complaint Survey Information (PDF)
  4. Child Care Complaint Survey Information Spanish (PDF)
  5. CCL 006 Reporting Suspected Abuse and Neglect (PDF)
  6. CCL 006 Reporting Suspected Abuse and Neglect Spanish (PDF)
  7. CCL 008 Licensing of Child Care (PDF)
  8. CCL 011 Recommended Health Supervision (PDF)
  9. CCL 012 Behavior and Guidance (PDF)
  10. CCL 012 Behavior and Guidance Spanish (PDF)
  11. CCL 025 Diapering of Children in Child Care (PDF)
  12. CCL 025 Diapering of Children in Child Care Spanish (PDF)
  13. CCL 036 Selecting Child Care Guide for Parents (PDF)
  14. CCL 037 Guidelines for Exclusion (PDF)
  15. CCL 037 Guidelines for Exclusion Spanish (PDF)

Other Resources