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Credentialing Requirements Checklist


The following documents are required for making application to be a StarrVista provider:

bulletW-9 Form
bulletLiability Insurance Policy Face Sheet
bulletProgram License or Certification (for each program)
bulletQuality Improvement Plan
bulletLetter of Accreditation
bulletFire Inspection
bulletEnvironmental Health Assessment
bulletVerification of non-profit status
bulletEEOC Policy
bulletProgram profile / description and brochures (for each program)
bulletStaff Roster with Degrees / Licensure
bulletLogic Model (for each program
bulletOutcome Data including concurrent and retrospective
bulletCultural Competency Policy
bulletList of Board of Directors
bulletTraining Schedule for last year and curriculum
bulletEducational Profile (residential only)
bulletAdventure-Based Profile (if applicable)
bulletMission, Values, Guiding Principles, etc.
bulletConsumer Protection Policy / Procedures
bulletSeclusion Policy / Procedure (residential only)
bulletBehavior Management Policy / Procedure
bulletLicensing / Rights Violations for past year


Bold = Not required for ancillary providers


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Last modified: 07/29/08