Permanent License Continuation Notice

After processing the completed continuation notice and fees, a new license will be sent to the provider’s mailing address. Failure to submit the completed continuation notice and fee by the anniversary date will cause the Division to assess fines and/or take action to revoke the child care license.

If you have a change of address, change in ownership or change in license type, a new original application MUST be submitted along with the original application fees.*

Go to New Application for Child Care License Form

* Adoption Agencies with an address change can use this form; all other facility/agency types (and Adoption Agencies with changes in license type or changes in ownership) must use the Original Application Form.

Licensing Specialist *

Anniversary Date *

See your current license for your anniversary date. Date is always the 1st of the month.

Provider Name *

Provider ID *

Type of License *

• Day Treatment
• Specialized Group Facility
• CPA Adoption
• Secure Residential Treatment Center
• Homeless Youth Shelter

Location Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Location County *

Please select one: *

• I want to continue my license
• Please close/terminate my license

Mailing address different

• Mailing address is different from Location Address above

Mailing Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Federal ID Number *

Director Name *

First

Last

Profit Status: *PublicPrivate For ProfitPrivate Not For Profit

Director's email address *

Capacity and ages of children in care *

Number of adoptions finalized in the last 12 months

For adoption agencies only

Conditions and restrictions *

Primary contact email address

If different from director email above

Contact email for receiving background results

Primary contact phone number *

Please terminate my license on *

(Closure date cannot be later than the anniversary date or you are required to pay the licensing fee.)

Signature of Licensee *

Clear Signature

Name of Designated Representative *

First

Last

Submit