Section 3: Applicant Affirmation (LI0023)

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Section 3: Applicant Affirmation (LI0023)

The Applicant Affirmation page is accessed either directly from the Program Information page or from the Continue selection on the Similar Program Address Warning page.

Applicant Affirmation Statement*

"My signature below attests to my understanding that this form constitutes a request for an Initial Licensing Visit only. I understand that I can not provide care, protection, and supervision services for children of more than two families until such time as I have received a License from the Child Care Services Division as required by Vermont state law (Title 33 Vermont Statutes Annotated, Section 3502)."

Affirmation Signature Present?*

If the application contains a signature, enter Yes in this field. If no signature date has been entered, enter No in this field.

Signature Date

Enter the signature date on the application in the format MM/DD/YYYY.

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Submitting Section 3 (LP)