Arkansas Online Application for Child Care License

Please provide the following information and click Submit.

Facility Name
Facility Type
If Child Care Center, what ages?	Infant (Birth to 18 months) Toddler (18 to 36 months) Preschool (2 1/2 to 5 yrs) School Age (Kindergarten & Up) Sick Care

Site Address 1			Mailing Address 1
Site Address 2		Mailing Address 2
Site City		Mailing City
Site State		Mailing State
Site Zip		Mailing Zip
Site County

Directions to this site
Facility Email
Facility Website

1. Have you attended Pre-License Orientation?

Yes Date Attended

2. Do you currently have children in your care?

Yes

How Many?

Date you plan to begin operation at this facility?

3. Were you previously licensed to provide child care in Arkansas or another state?
Yes
No

4. Has anyone in your immediate family (blood relative; by marriage; etc.) or anyone affiliated with
your Facility (sharing common ownership; board member; or any other interest) ever been debarred,
terminated, suspended or otherwise excluded from participation by a government unit?
Yes
No

4.a. If the answer is 'Yes' to either #3 or #4, please fill out the following information about previously licensed facilities:

Facility #1

Facility #2

Facility #

Facility Name

City

State

Start Date

End Date

4.b. If the answer is 'Yes' to #4, please fill out the following information about related exclusions:

	Facility #1 (continued from above)		Facility #2 (continued from above)
Name of the Person		Name of the Person
Relationship to you?		Relationship to you?
Explanation		Explanation

5. Enter the following Owner Information (Enter Corporate or Individual Owner Names, not both):

Owner Info	Primary Owner	Other Owner	Other Owner
TIN (Tax ID) if applicable
SSN if no TIN
Corporate Owner Name
Individual First Name
Individual Last Name
Address 1
Address 2
City
State
Zip
Owner Phone
Owner Cell
Owner Email

6. Months of Operation

7. Hours of Operation

	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
Open
Close
Open
Close

Please note that Child Care Licensure applicants are subject to Arkansas State Criminal Background Checks, FBI Background Checks and Child Maltreatment Registry Checks. The application could be impacted depending on the information that is obtained as a result of those checks.

This application will not be considered complete until ALL information has been provided.

The following items must be submitted to your assigned Licensing Specialist. You will be contacted by your Licensing Specialist:

1.	Diagram of the facility/building, which indicates rooms that will be used by children, and locations for hand washing and toileting.
2.	Criminal record, child maltreatment, central registry, and FBI record checks on applicant.
3.	Copies of fire and health department approvals, if applicable.
4.	Zoning approval.
5.	Arkansas Manufactured Home Commission approval, if applicable.
6.	Rates. A Rates Worksheet can be found under the Resources link on this page.
7.	Licensed/Registered Homes only – Name all caregivers with their ages, addresses, and phone numbers, and name all residents of the home.
8.	Child Care Centers only – Name of proposed director and documentation of their qualifications.
9.	Child Care Centers only – If owned by a corporation, attach a copy of board member names, addresses, and phone numbers. In addition, a copy of articles of incorporation, which have been filed with the Arkansas Secretary of State, and any amendments, shall also be attached.
10.	Verification of your TIN or SSN #.

Under the provisions of the Child Care Licensing Act 434 of 1969, amended, I hereby make application for license/registration to operate a child care center/home. I have reviewed the minimum licensing/registration requirements and agree to comply with them.

	** A letter of authorization is required if the person submitting this application is anyone other than an owner.
	Before submitting, print a copy of the application for your records.

All	Jan	Feb	March	April	May	June
	July	Aug	Sept	Oct	Nov	Dec

Arkansas Child Care Information

Division of Child Care and Early Childhood Education

Arkansas Online Application for Child Care License