Full Physical Address:
Mailing Address if Different:
Primary Representatives Email:
Additional Representative (include email address):
|Type of Service Provided (mark all that apply)|
|Proctor Care |
|Independent Living |
|In-home Services |
|Professional Parenting |
|Diagnostic Specialty (mark all that apply) |
|Substance Abuse |
|Co-occuring Diagnosis |
|Mental Health |
|Behavioral Health |
|Eating Disorders |
|Victims of Domestic Violence |
Number of Full Time Equivalent Employees:
Annual Dues Structure
Full Time Equivalent Administrative & Direct Care Youth Services Employees
FTE Employees Annual Dues
0 - 20 $ 300
20 - 40 $ 600
40 - 80 $1,250
80 - Plus $2,500
Please complete the following questions as part of your application.
These questions enable YPA to promote your membership and the Association as having the highest of standards within the industry and the community. All answers remain confidential and will not be distributed.
|1. This agency passed our state audits during the past two years.|
|2. Within the last two years, this agency has been successful in not being placed on moratorium and/or sanctioned.|
|3. Within the last two years, this agency has been successful in not having its license suspended or revoked.|
|4. This agency is in good standing with the Utah Department of Human Services.|
|This agency providers Trauma Informed Care. |
|This agency uses an outcome data collection tool to drive treatment. |
If yes, please identify the tool(s) used within your agency.
|This agency uses an Evidence Based Practice model to drive treatment. |
If yes, please identify the model used.
|This agency employs individuals with areas of specialized expertise who are willing to provide training to other YPA members.|
If yes, please identify areas of expertise.
|This agency agrees to provide anonymous feedback and participate in surveys sent by the YPA throughout the year. |
Application Completed by:
Please submit your Membership Application at this web site, by email, by mail, or in person at a monthly Membership Meeting. YPA will contact you regarding the status of your application within two weeks. A YPA Membership Application wll be presented to your agency upon approval of the Membership Application and receipt of dues. Thank you!
Youth Providers Association, Inc.
230 South 500 East
Springville, UT 84663