Day Program - Authorization to Exceed 10 People

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If your Day Program space is made up of more than one separate suite or area, it is possible it could be counted as different settings and exceed the 10 person maximum. Please complete the following information to receive Department approval.

Email *

What is the name of your agency? *

What Type of Service do you Provide? *

How many separate areas/suites does your setting have? *

Does each area/suite have its own entrance? *

Yes

Does each area/suite have its own restrooms and facilities? *

Yes

Does each area/suite have its own dedicated staff? *

How many staff and members do you intend to have in each area/suite? *

Would members/staff in the separate suites/areas come in contact with one another? *

Does each area/suite have its own HVAC system? *

Yes

Does each area/suite have at a minimum of 50 square feet per member? *

Yes

Is there anything else you would like to tell us about the setting? *

Submit

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