Provider Application Form | Aricares Alliance

top of page

DONATE

Home
About
Program
Resources
Get Involved
Contact

Name (First, Last)

Website

Provider Name

Phone number

City

Zip code

State

Service category

State operating license

Upload

Choose a date

Do you hold all required state, county, and local licenses to operate, and are they currently in good standing without severe citations? *

Yes

Does your organization maintain active general and professional liability insurance, as well as active workers' compensation coverage? *

Yes

Do you mandate and conduct comprehensive criminal background checks (DOJ/FBI) on 100% of your staff before they have contact with seniors? *

Yes

Do you pledge to provide families with clear, transparent pricing contracts completely free of hidden fees or predatory cancellation clauses? *

Yes

By checking this box, I attest that I am an authorized representative of this organization. I swear that all information provided is accurate. I agree to uphold the Aricares Alliance Ethical Care Pledge. I understand that Aricares Alliance reserves the right to remove any provider from the directory at any time if these standards are violated.

Upon clicking submit, you will be directed to our secure payment portal to process your Annual Alliance Membership Fee. Your application will then enter 'Pending' status while our team reviews your credentials. If your application is denied, your fee will be refunded in full.

There is no fee to submit an application. Once your application has been reviewed and approved, your organization will be eligible for a complimentary Basic Directory Listing.