Membership Application 

Approved by YPA Membership on December 3, 2008.





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Membership Application

Date: 

Company:

Representatives:

Full Address:

Email:

Phone:

Type of Services Provided:

Number of Full Time Equivalent Employees:

Dues Owed:

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.
Yes  No 
 
2. Within the last two years, this agency has been successful in not being placed on moratorium and/or sanctioned.
Yes  No 
 
3. Within the last two years, this agency has been successful in not having its license suspended or revoked.
Yes  No 
 
4. This agency is in good standing with the Utah Department of Human Services.
Yes  No 
 

Comments:

Application Completed by:

Title:

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

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