NHSSRegulation and Licensure 2026

1. Click ‘Get Form’ to open the NHSSRegulation and Licensure document in the editor.
2. Begin by entering your current name in the designated field, ensuring to include any suffixes such as Jr/Sr/II/III.
3. Indicate your gender by selecting M or F from the options provided.
4. If applicable, list any other names you have used (e.g., maiden names, aliases) in the corresponding field. If none, write 'NONE'.
5. Sign and date the form where indicated to authorize background checks against the Nebraska Child Abuse/Neglect Register.
6. Provide a complete address history for the past 20 years or since age 13, including street addresses, city, state, and dates of residence.
7. List full names and dates of birth for your children. If you have no children, write 'NONE'.
8. Complete the section for licensed child care provider information with facility name, phone number, address, and license number.

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