STEPS Provider Agency Qualifications Checklist

To add or modify the services that your organization is qualified/licensed/certified to provide, please complete, sign and submit this form.
List one county per line.
Populations Served:

If you have questions about the below services, check the Description of STEPS Agency Provider Services.
Please check all areas your agency has training, qualifications, licenses and/or certifications for services that your agency wishes to provide to STEPS program participants.

Our organization completes background checks on all agency employees that will be serving STEPS participants as outlined in the STEPS Program Policy Manual. Please acknowledge the following: I understand that our agency must ensure that there is no conflict of interest directing participants to our agency or organization without considering other service providers. Our agency cannot provide services for family members, relatives or friends of employees or allow employee family members or relatives to provide STEPS services for participants.
Please download and sign the below STEPS Provider Checklist Signature Sheet and upload the signed and dated sheet here.