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APPLICATION

Please note: The following downloads are available in Adobe Acrobat (version 6.0) file format. This file format is read-only and print-only (not editable). You will need the Adobe Acrobat Reader to download these files. The Acrobat Reader is available FREE OF CHARGE at Adobe's website. THIS LINK will take you to Adobe's site. Follow the instructions there for downloading the Acrobat Reader.

 

 

Thank you for your interest in applying to the DVOMB Approved Provider List. Before completing your application be sure to read and understand the Qualifications Section 9.0 of the Standards. There are four application levels. Please note that all application fees are non-refundable:


1. Application for Entry Level (see Section 9.01 of the Standards)
2. Application for Provisional Level (see Section 9.07 of the Standards)
        A. Standard Provisional          B. Judicial Rural Initiative
      The above two applications are used to request approval primarily based upon a well documented community need which cannot be met       by existing providers. Please call the Application Review Coordinator at 303-239-4536 to discuss how our rural programs may apply to you.
3.
4.
Application for DV Clinical Supervisor Level (see Section 9.03 of the Standards)
The above application is for individuals who have been approved and practicing at the Full Operating Level for a minimum of one year.

Specific Offender Population Application (see Section 10.0 of the Standards) This is an additional application to be used either by a DVOMB Approved Provider or an individual applying to be a provider to request approval to treat a specific offender population. Currently we offer appoval for  treating females or same sex partners.

Are you already approved by the Sex Offender Management Board as a Full Operating Level Adult Treatment Provider or Evaluator? If yes, please call our Application Review Coordinator at 303-239-4536 for more information about applying to the DVOMB's Approved Provider List.

 

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