"Application for License Amendment" - Georgia (United States)

Application for License Amendment is a legal document that was released by the Georgia Department of Early Care and Learning - a government authority operating within Georgia (United States).

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Child Care Services Division
BRIGHT FROM THE START: Georgia Department of Early Care and Learning
APPLICATION FOR LICENSE AMENDMENT
Current name of Facility (d/b/a):
Legal Name of Facility
Site Address:
Telephone:
(
)
Area Code
City:
Zip:
-
Mailing Address:
City:
Zip:
County:
REASON(S) FOR REQUESTED AMENDMENT TO LICENSE
(
CHECK ALL THAT APPLY
)
Change in name of program only:
Proposed
name:
Effective date:
to serve age groups not previously served, e.g., infants
Change in ages of children served (
)
Present ages served:
to
New ages to be
to
served:
Effective date:
Change in hours:
Present hours:
to
New hours:
to
Effective date:
Change in licensed capacity or use of the building:
Attach an updated floor plan of the facility showing details of the area involved. Also attach copies of
(applicable) local approvals, i.e., fire, building, and zoning location. Indicate on your floor plan the
location of all sinks, toilets, diaper changing tables and exhaust fans.
Comments:
I represent that the official address listed on this application is current and correct. I will notify the Bright from the Start in writing if my address
changes or if additional changes are required.
I understand that I am responsible for meeting all applicable rules and regulations associated with these changes.
Owner
Board Chairman (if applicable)
Director
Date
For office use only
Amended License:
issued
no new license needed
Program Specialist
Date Approved
Child Care Services Division
BRIGHT FROM THE START: Georgia Department of Early Care and Learning
APPLICATION FOR LICENSE AMENDMENT
Current name of Facility (d/b/a):
Legal Name of Facility
Site Address:
Telephone:
(
)
Area Code
City:
Zip:
-
Mailing Address:
City:
Zip:
County:
REASON(S) FOR REQUESTED AMENDMENT TO LICENSE
(
CHECK ALL THAT APPLY
)
Change in name of program only:
Proposed
name:
Effective date:
to serve age groups not previously served, e.g., infants
Change in ages of children served (
)
Present ages served:
to
New ages to be
to
served:
Effective date:
Change in hours:
Present hours:
to
New hours:
to
Effective date:
Change in licensed capacity or use of the building:
Attach an updated floor plan of the facility showing details of the area involved. Also attach copies of
(applicable) local approvals, i.e., fire, building, and zoning location. Indicate on your floor plan the
location of all sinks, toilets, diaper changing tables and exhaust fans.
Comments:
I represent that the official address listed on this application is current and correct. I will notify the Bright from the Start in writing if my address
changes or if additional changes are required.
I understand that I am responsible for meeting all applicable rules and regulations associated with these changes.
Owner
Board Chairman (if applicable)
Director
Date
For office use only
Amended License:
issued
no new license needed
Program Specialist
Date Approved