Voluntary Closure Days Request FormEnglish closure form Preview on Page 1

Voluntary Closure Days Request FormEnglish closure form 2026

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  1. Click ‘Get Form’ to open the Voluntary Closure Days Request Form in the editor.
  2. In Section 1, enter your Provider Name and Provider ID Number. Ensure that your contact phone number is accurate for any follow-up communications.
  3. Indicate the specific day(s) you plan to be voluntarily closed by selecting the appropriate dates.
  4. Move to Section 2 and input the Begin Date and End Date of your closure using the MM/DD/YY format. Remember, you can only request payment for up to two consecutive weeks of voluntary closure per year.
  5. In Section 3, check the box certifying that all parents have been notified about this closure. Finally, provide your signature and date to complete the form.

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