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Divisions
Divisions > Early Childhood Development > Licensing
Fill-in Licensing Forms

Licensing Forms - Fill-in Enabled
                               Versions

Each of the forms listed below can be filled out on-screen by (1) downloading and saving the document to your hard-drive, then (2) opening the document back up and typing the requested information into the gray fields provided next to the items on the form.  These forms are "protected" to allow you to move from field to field simply by pressing the TAB key on your keyboard.  (NOTE: If you unprotect a form, it will lose this "tab-to-field" ability.  To restore that ability, you will need to go to "Tools" on your main toolbar and select "Protect Document.")

When you have completed the form, you can either print it out and send it to your OCC Regional Licensing Office, or e-mail it to your Regional Licensing Office as an attachment if it does not require an original signature.  As a precaution, we recommend that you save the completed form on your hard-drive before printing it out or attaching it to an e-mail.

Important: Some of the forms below require one or more original (i.e., hand-written) signatures.  Before you submit a form to your Regional Licensing Office, please make sure that it has all the necessary signatures.

After each form below, one of the the following indicators is used to show what type of child care facility the form is used for:

·          (HOME) - family child care homes

·          (CTR/LOC) - child care centers and letter of compliance facilities

·          (CTR) - child care centers only

·          (LOC) - letter of compliance facilities only

·          (ALL) - centers, homes, and letter of compliance facilities

If you have any questions about the use of a form, please contact your Regional Licensing Office.


Form Number

Title/Description

 

 

100  

Professional Development Plan (CTR)

 

101A

Professional Development Plan-1st Year(HOME)

101B 

Professional Development Plan-Continuing (HOME)

101C 

FDC Applicant – Initial Training Requirements (HOME)

349

Application to Resume Service (HOME)

 

670

Announced Inspection Preparation Checklist - Child Care Centers and Letter of Compliance Facilities (CTR/LOC)

 

671

Announced Inspection Preparation Checklist - Family Child Care Homes (HOME)

 

672

Request for Continuing License or Letter of Compliance (CTR/LOC)

 

673

Request for Continuing Registration (HOME)

 

1200

Application - Initial (CTR/LOC)

 

1201

Insurance Information (CTR/LOC)

 

1203

Personnel List & Staff Change Report (CTR/LOC)

 

1204

Medical Report for Child Care (ALL)

 

1205

Personnel Information (CTR)

 

1206

Staffing Pattern (CTR/LOC)

 

1209

Changes in Facilities (CTR/LOC)

 

 

1213

Variance Request (ALL)

 

 

1215

Health Inventory (ALL)

 

1216

Medication Administration (ALL)

1218

Menu Plan (CTR/LOC)

 

1229

Substitute Form (HOME)

 

1230

Application - Initial (HOME)

 

 

1260

Release of Information (ALL)

 

1261

Emergency Escape Plan (HOME)

 

1267

Provider Information & Plan of Operation (HOME)

 

1268

Environmental Health Survey (ALL)

 

1270

Notice of Intent to Operate (CTR/LOC)

 

1275

Additional Adult Application (HOME)

 

1281

Request for Hearing (ALL)

 

1285

Health History - Drop -in (CTR)

 

1295

Self - Assessment Guide (HOME)

 


Contact Information
Maryland State Department of Education
200 West Baltimore Street
Baltimore, MD 21201
Maryland State Department of Education
200 West Baltimore Street
Baltimore, MD 21201
 Licensing Branch
Licensing Home Page
Regional Licensing Offices
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