Green Apple Accreditation of Children's Services

Self Study Review Request

Reminder: This form should be submitted by the designated representative (Accreditation File Builder) for the Organization. You may start the Self Study, save it, and complete it later.

Instructions: Programs must complete the Self-Study Review Request form to either 1) request review of the self-study evaluation and supporting evidence or 2) request extension of time to submit the self-study. The program must request an extension of time if the self-study is not completed within ten months from the date of application. An extension of time fee will apply.

Have you submitted the Self Study Evaluation and Evidence? *
Self-Study Review (Check ONE only) *

NOTE: This form must be complete and include BOTH today’s date and the date of the program’s current accreditation application. If an Extension of Time is requested, then the program must include the Credit Card Authorization form along with the form. The cost for an extension of time is $365.00 and must be paid in full before this request may be approved.


Signature *