Form DHS951 "Application for License to Operate a Group Child Care Center or Group Child Care Home" - Hawaii

What Is Form DHS951?

This is a legal form that was released by the Hawaii Department of Human Services - a government authority operating within Hawaii. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2003;
  • The latest edition provided by the Hawaii Department of Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DHS951 by clicking the link below or browse more documents and templates provided by the Hawaii Department of Human Services.

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Download Form DHS951 "Application for License to Operate a Group Child Care Center or Group Child Care Home" - Hawaii

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State of Hawaii
DEPARTMENT OF HUMAN SERVICES
APPLICATION FOR LICENSE TO OPERATE
A GROUP CHILD CARE CENTER OR GROUP CHILD CARE HOME
The sponsoring organization, agency or individual identified below who is legally responsible for the
administration and payment of debts and obligations, hereby apply for a license to operate a group child center
or group child care home in compliance with Section 346-161, Hawaii Revised Statutes.
Name of Facility:
Address:
Mailing Address:
Telephone No.:
Fax No.:
EIN:
General Excise Tax Number:
Name of Director of child care program
Have you ever applied for a Group Child Care license before?
If yes, what was the name of
your facility and date of operation?
Have you ever been associated with another child care program?
If yes, what is/was
the name of the program and date?
Include:
1.
A copy of statement of operation policies.
2.
Information on staff members.
3.
Statement of lega l authority.
*4.
One copy of the floor plan of the center, including basic measurements, and fire
evacuation plan. (8-1/2” X 11”)
*5.
One copy of the plot plan, including basic measurements (8-1/2” X 11”)
I have read the Rules Governing Licensing of Group Child Care Centers and Group Child Care Homes. I
understand that in making this application, a study of the facility and this program will be made.
(Date)
Signature (Director/Owner/Operator/Principal)
*Omit for application for renewal of License if there is no change at time of reapplication.
Return to:
DHS 951 (11/03)
Page 1
State of Hawaii
DEPARTMENT OF HUMAN SERVICES
APPLICATION FOR LICENSE TO OPERATE
A GROUP CHILD CARE CENTER OR GROUP CHILD CARE HOME
The sponsoring organization, agency or individual identified below who is legally responsible for the
administration and payment of debts and obligations, hereby apply for a license to operate a group child center
or group child care home in compliance with Section 346-161, Hawaii Revised Statutes.
Name of Facility:
Address:
Mailing Address:
Telephone No.:
Fax No.:
EIN:
General Excise Tax Number:
Name of Director of child care program
Have you ever applied for a Group Child Care license before?
If yes, what was the name of
your facility and date of operation?
Have you ever been associated with another child care program?
If yes, what is/was
the name of the program and date?
Include:
1.
A copy of statement of operation policies.
2.
Information on staff members.
3.
Statement of lega l authority.
*4.
One copy of the floor plan of the center, including basic measurements, and fire
evacuation plan. (8-1/2” X 11”)
*5.
One copy of the plot plan, including basic measurements (8-1/2” X 11”)
I have read the Rules Governing Licensing of Group Child Care Centers and Group Child Care Homes. I
understand that in making this application, a study of the facility and this program will be made.
(Date)
Signature (Director/Owner/Operator/Principal)
*Omit for application for renewal of License if there is no change at time of reapplication.
Return to:
DHS 951 (11/03)
Page 1