"Designation of Adminstrative Authority" - Massachusetts

Designation of Adminstrative Authority is a legal document that was released by the Massachusetts Department of Early Education and Care - a government authority operating within Massachusetts.

Form Details:

  • Released on January 22, 2014;
  • The latest edition currently provided by the Massachusetts Department of Early Education and Care;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Massachusetts Department of Early Education and Care.

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DESIGNATION OF ADMINSTRATIVE AUTHORITY
SMALL GROUP, LARGE GROUP AND SCHOOL AGE CHILD CARE
Name of Licensee: ________________________________________________________________
Name of Program: ________________________________________________________________
Small Group or Large Group_____________________________ Capacity____________________
Address:_________________________________________________________________________
As Licensee for the above named program, I designate the following individual(s) as the person(s) duly
authorized to act as an agent for the licensee, and who shall be responsible for the program administration
as set forth in the administrative plan. The individual(s) designated meet the requirements of 606 CMR
7.04 17(m)
Program Administrator (1)_________________________________________________________________
Scheduled Administrative Hours:_____________________ Scheduled Teaching Hours:________________
Program Administrator (2):_________________________________________________________________
Scheduled Administrative Hours:_____________________ Scheduled Teaching Hours:________________
Site Coordinator:_________________________________________________________________________
Scheduled Administrative Hours:_____________________ Scheduled Teaching Hours:_________________
DESIGNATION OF ADMINSTRATIVE RESPONSIBILITY
(When indicating “Person Responsible”, include the person’s hours if the person is not the designated
Administrator noted above.) * Attach a current staff schedule including administration.
RESPONSIBLITIY
PERSON(S) RESPONSIBLE
Business Management/Record Keeping:
account/books
_______________________
records
_______________________
personnel records
_______________________
children’s records
_______________________
financial documentation
_______________________
staff schedules
_______________________
Development and Maintenance of Programming:
early childhood education program
_______________________
kindergarten
_______________________
school age
_______________________
services for children w/disabilities
_______________________
daily activities
_______________________
equipment
_______________________
Page 1 of 2
SG/LG/SAAdminAuthorityDesignation20140122
DESIGNATION OF ADMINSTRATIVE AUTHORITY
SMALL GROUP, LARGE GROUP AND SCHOOL AGE CHILD CARE
Name of Licensee: ________________________________________________________________
Name of Program: ________________________________________________________________
Small Group or Large Group_____________________________ Capacity____________________
Address:_________________________________________________________________________
As Licensee for the above named program, I designate the following individual(s) as the person(s) duly
authorized to act as an agent for the licensee, and who shall be responsible for the program administration
as set forth in the administrative plan. The individual(s) designated meet the requirements of 606 CMR
7.04 17(m)
Program Administrator (1)_________________________________________________________________
Scheduled Administrative Hours:_____________________ Scheduled Teaching Hours:________________
Program Administrator (2):_________________________________________________________________
Scheduled Administrative Hours:_____________________ Scheduled Teaching Hours:________________
Site Coordinator:_________________________________________________________________________
Scheduled Administrative Hours:_____________________ Scheduled Teaching Hours:_________________
DESIGNATION OF ADMINSTRATIVE RESPONSIBILITY
(When indicating “Person Responsible”, include the person’s hours if the person is not the designated
Administrator noted above.) * Attach a current staff schedule including administration.
RESPONSIBLITIY
PERSON(S) RESPONSIBLE
Business Management/Record Keeping:
account/books
_______________________
records
_______________________
personnel records
_______________________
children’s records
_______________________
financial documentation
_______________________
staff schedules
_______________________
Development and Maintenance of Programming:
early childhood education program
_______________________
kindergarten
_______________________
school age
_______________________
services for children w/disabilities
_______________________
daily activities
_______________________
equipment
_______________________
Page 1 of 2
SG/LG/SAAdminAuthorityDesignation20140122
Staff Development
_______________________
Staff Training
_______________________
Staff Orientation
_______________________
Staff Supervision
_______________________
Parent Involvement
_______________________
Social Services
_______________________
Infant/Toddler Program, if applicable
(must be Lead Teacher Qualified)
_______________________
___________________________________
_______________________
(Licensee Signature)
(Date)
Page 2 of 2
SG/LG/SAAdminAuthorityDesignation20140122
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