Program Annual Report

STEP BY STEP PROCESS:

CONTINUAL ACCREDITATION: To maintain accreditation, the Accredited Program must submit an annual report and applicable nonrefundable fee no later than June 30th every year with exception to the year of initial accreditation/re-accreditation. See Program Annual Report.

Who should complete the Program Annual Report - This form should be submitted by the designated representative (Accreditation File Builder) for the Organization. You may start the Program Annual Report, save it, and complete it later.

REMINDER: You may begin the Annual Report on March 1st. The Program Annual Report is due by June 30th, every year. Providers (behavioral health and education) must complete the Annual Report to maintain accreditation.

Name of person submitting Program Annual Report. *

Title *

PROVIDER INFORMATION

Name of Organization *

Provider Type *

Behavioral Health - $300

Education -$250

Physical Address *

City *

State *

Zip Code *

Country

Phone

Alternate Phone

Email Address *

Website

UPDATE INFORMATION

Substantive and Other Program Changes

(Check all applicable): Has there been a change in the following program/services? *

Explain all program changes including but not limited to: ownership, staff, reduction or increase in services, location, program changes, and so on. If there were no program changes then type None. *

Insurance

Insurance [All Programs/Providers]:

All programs shall include a copy of the annual liability insurance showing Amen Always Ministries International, Inc., Green Apple Accreditation of Children’s Services as an additional insured. You will need to make sure the current mailing address is on the declaration page. The current mailing address is: 731 Duval Station Road #107-147, Jacksonville, Florida 32218

I/We acknowledge the Insurance [Additional Insured] Policy and will remain in compliance. *

YES

NO

Accreditation Notification [All Programs]

Accreditation Notification [All Programs/Providers]:
All programs shall include a parent handbook, brochure, or website address, etc., showing the most CURRENT
status of membership, affiliation, or accreditation with Green Apple Accreditation of Children’s Services, as
proper notice to parents/public. No program may continue to advertise itself as a member, affiliated with, certified by, or accredited with Green Apple Accreditation of Children's Services, if/when its status has been suspended, revoked, or terminated for cause.

I/We acknowledge the Accreditation Notification Policy and will remain in compliance. *

YES

NO

PROGRAM REQUIREMENTS

All Programs

Directions: Upload the required documentation if there have been any changes such as new inspection reports, personnel, etc. If there were no changes then upload a signed page stating there were no changes since last year or date of accreditation.

Background Screening for New Personnel *

List of Current Personnel *

Insurance Declaration Page *

Licensing Inspection Reports (past 2 years) *

Provider Type Requirements

Behavioral Health Programs. NO ADDITIONAL REQUIREMENTS.

Early Education Centers and Enrichment Programs.

Ratio and Group Size

In-Service Training Certificates

Transportation Maintenance Logs

Proof of Child Safety Alarm

Public/NonPublic Schools.

Any and all student records which may become necessary if the school were to close.

Standardized Test Scores

List of graduating seniors,

Report Cards

Student Transcripts

Affirmation and Signature

Certification

Be it resolved that we, the governing body of this organization do hereby declare that we have answered the above statements honestly and in complete accordance with the basis, principles, and policies that govern this organization and that a motion to this effect is recorded in the official minutes of the organization. We indemnify and hold harmless Green Apple Accreditation of Children's Services (GAACS), its representatives, successors, and its members both now and forever. Furthermore, I certify that I have the authority to complete this application on behalf of the organization. I/We have read and agree to the REFUND POLICY, FEES, AND TERM LIMITS and understand that ALL FEES ARE NONREFUNDABLE and NONTRANSFERABLE. The transaction may not be canceled once it is processed. There are additional FEES for Site Visit (Survey) Inspections and Travel Expenses (may be assessed), which will be due in furtherance of this application for accreditation. I/We have also read and agree to the PRIVACY POLICY and POLICIES AND PROCEDURES MANUAL.

Name *

Title *

Today's Date *

Signature *

clear

Location Address Change	Additional Location(s)
Change of Ownership	Staff Leadership
Reduction in Personnel	Increase in Personnel
Reduction in Program/Services	Increase in Program/Services
Major Repairs or Renovations	Fire/Loss/Casualty
Change of Name	Other Other