Section R9-3-201. Application for a Certificate

An applicant for a certificate shall:

1.        Be at least 21 years of age, and

2.        Submit to the Department an application packet contain- ing:

a.        An application on a form provided by the Depart- ment that contains:

i.         The applicant’s name and date of birth;

ii.        The name to be used for the child care group home, if any;

iii.      The address and telephone number of the resi- dence;

iv.      The mailing address of the applicant, if differ- ent from the address of the residence;

v.        The applicant’s contact telephone number, if different from the telephone number of the resi- dence;

vi.      The applicant’s e-mail address;

vii.     The name of the provider, if different from the applicant;

viii.   The requested capacity for the child care group home;

ix.      The anticipated hours of operation for the child care group home;

x.        Whether the applicant agrees to allow the Department to submit supplemental requests for information;

xi.      Whether the applicant or any controlling person has been denied a certificate or license to oper- ate a child care group home or child care facil- ity in this state or another state or has had a certificate or license to operate a child care group home or child care facility revoked in this state or another state and, if so:

(1)     The name of the individual who had the certificate or license denied or revoked,

(2)     The reason for the denial or revocation,

(3)     The date of the denial or revocation, and

(4)     The name and address of the certifying or licensing agency that denied or revoked the certificate or license;

xii.     A statement that the applicant has read and will comply with A.R.S. Title 36, Chapter 7.1, Arti- cle 4 and this Chapter;

xiii.   A statement that the applicant has sufficient financial resources to comply with A.R.S. Title 36, Chapter 7.1, Article 4 and this Chapter;

xiv.   A statement that the information provided in the application packet is accurate and complete; and

xv.     The applicant’s signature and date the applicant signed the application;

b.        A copy of the applicant’s:

i.         U.S. passport,

ii.       Birth certificate,

iii.      Naturalization documents, or

iv.      Documentation of legal resident alien status;

c.        A copy of the applicant’s valid fingerprint clearance card issued according to A.R.S. Title 41, Chapter 12, Article 3.1;

d.        A copy of the form required in A.R.S. § 36- 897.03(B) for the applicant;

e.        A document issued by the Department showing that the applicant has completed Department-provided orientation training that included the Department’s role in certifying and regulating child care group homes under A.R.S. Title 36, Chapter 7.1, Article 4, and this Chapter;

f.         A floor plan of the residence where child care ser- vices will be provided, showing:

i.         The location and dimensions of each room in the residence, with designation of the rooms to be used for providing child care services;

ii.        The location of each exit from the residence;

iii.      The location of each sink and toilet available for use by enrolled children;

iv.      The location of each smoke detector in the resi- dence; and

v.        The location of each fire extinguisher in the residence;

g.        A site plan of the premises showing:

i.         The location and dimensions of the outdoor activity area;

ii.        The height of the fence around the outdoor activity area;

iii.      The location of each exit from the outdoor activity area;

iv.      The location of the residence;

v.        The location of each swimming pool, if appli- cable;

vi.      The location and height of the fence around each swimming pool, if applicable; and

vii.     The location and dimensions of any other building or structure on the premises, if appli- cable;

h.        If the child care group home is located within one- fourth of a mile of agricultural land:

i.         The names and addresses of the owners or les- sees of each parcel of agricultural land located within one-fourth mile of the child care group home, and

ii.        A copy of an agreement complying with A.R.S.

§ 36-897.01(B) for each parcel of agricultural land;

i.         The applicable fee in R9-3-203; and

j.         If the applicant is a business organization, a form provided by the Department that contains:

i.         The name, street address, city, state, and zip code of the business organization;

ii.        The type of business organization;

iii.      The name, date of birth, title, street address, city, state, and zip code of the designated agent;

iv.      The name, date of birth, title, street address, city, state, and zip code of each other con- trolling person;

v.        A copy of the business organization’s articles of incorporation, articles of organization, partner- ship documents, or joint venture documents, if applicable; and

vi.      Documentation of good standing issued by the Arizona Corporation Commission and dated no earlier than three months before the date of the application, if applicable.

Historical Note

New Section made by final rulemaking at 10 A.A.R. 1214, effective September 1, 2004 (Supp. 04-1). Amended by exempt rulemaking at 15 A.A.R. 2091, effective January 1, 2010 (Supp. 09-4). Amended by

exempt rulemaking at 17 A.A.R. 1530, effective September 30, 2011 (Supp. 11-3).