Currently Certified Chemical Dependency Service Provider Application-type Forms

• Certified Provider Branch Agency Certification
  Branch Application Form
  Instructions
  Sample Floor Plan
  ADA Checklist for Existing Facilities
   
• Certified Provider Added Service Certification
  Added Services Application form
  Instructions
  Sample Floor Plan
  ADA Checklist for Existing Facilities
   
• Change of Ownership Application (CHOW)
  CHOW Application Form
  CHOW Instructions
   
• Administrator Change Notification Form
   
• Criminal Background Check form (from Washington State Patrol) [PDF Fill-In]  
  Must use the Request for Child/Adult Abuse Info Act form. To access the form in Word or PDF, click on "FORMS" on the WSP WATCH website https://watch.wsp.wa.gov/Help?Index=forms
   
• Voluntary Certification Suspension/Cancellation Request Form for an agency, branch, or service

• Agency Relocation Approval Request Form and Sample Floor Plan

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