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NHSSRegulation and Licensure 2026
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- Click ‘Get Form’ to open the NHSSRegulation and Licensure document in the editor.
- Begin by entering your current name in the designated field, ensuring to include any suffixes such as Jr/Sr/II/III.
- Indicate your gender by selecting M or F from the options provided.
- If applicable, list any other names you have used (e.g., maiden names, aliases) in the corresponding field. If none, write 'NONE'.
- Sign and date the form where indicated to authorize background checks against the Nebraska Child Abuse/Neglect Register.
- Provide a complete address history for the past 20 years or since age 13, including street addresses, city, state, and dates of residence.
- List full names and dates of birth for your children. If you have no children, write 'NONE'.
- Complete the section for licensed child care provider information with facility name, phone number, address, and license number.
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