Approved Submitter Request Form

Criteria

The form below can be used to request access to submit documents to Northern Lights on behalf of staff members.

To access this tool, you must meet one of the criteria listed below:

Public School
1. CBCCPP or ASP that is owned/operated by a public school, school district, or supervisory union.
Single Site Licensed for 60+
1. CBCCPP or ASP program licensed to provide care for 60+ children.
Multiple Sites licensed for a total of 100+
1. Single owner/license with multiple CBCCPP and/or ASP programs which are licensed to provide care for a combined total of 100+ children between all programs.

Note: If you meet the criteria for option two and option three, please select option two ("Single Site Licensed for 60+"), and fill out the form for your largest program.

* Please select an option from the list below.

Public School

Single Site Licensed for 60+

Multiple Sites licensed for a total of 100+

Public School

Please type the name of your public school into the search bar below.

Note: If you oversee several different Public School programs (e.g. a Supervisory Union or School District) please select one school within your Supervisory Union or School District, and complete the form one time. If eligible, you will be granted permission to submit documents on behalf of all programs that you oversee.

If your school's name does not appear as one of the options listed, please contact Northern Lights.

* Name of Public School Program (as it appears in BFIS)

* Please select an option below to continue

I have entered my school

I was unable to enter my school

Single Site Licensed for 60+

Please type the name of your CBCCPP/ASP into the search bar below.

If your program's name does not appear as one of the options listed, please contact Northern Lights.

* Name of CBCCPP/ASP (as it appears in BFIS)

* Please select an option below to continue

I have entered my CBCCPP/ASP

I was unable to enter my CBCCPP/ASP

If you were unable to find your program but believe that it meets the criteria that you selected, please contact Northern Lights.

Contact Information

* Contact First Name

Contact Preferred Name

* Contact Last Name

* Contact Phone Number

* Contact Email Address

As the Contact for the above listed Organization, I understand and agree to the following requirements of the Northern Lights system:

Any documents submitted via our Approved Staff Submission portal must meet the following criteria:

You may only submit documents for one staff member per submission
You must submit your documents as a single PDF file
Your submission must include a completed Verification Cover Sheet for the staff member whose documents are being submitted

* Once you have read the above, please type your full name in the box below to mark your agreement.

Other Criteria

If you are an owner/licensee of multiple CBCCPP and/or ASP programs which are licensed to provide care for for a combined total of 100+ children between all programs, you may request a review of your eligibility by Northern Lights staff.

Please provide the required information below, and a Northern Lights staff member will determine your eligibility.

* First Name:

* Preferred Name:

* Last Name:

* Phone:

* Email:

* Please describe your role:

* Please list the program(s) that you are responsible for, as their names appear in BFIS:

* Please add any additional notes or comments here:

* By signing the below, you acknowledge that you are requesting a review of your eligibility for the approved submission portal.

Completion of this form does not guarantee access to this portal.