Kentucky Department of Corrections Division of Probation 2026

1. Click ‘Get Form’ to open the Kentucky Department of Corrections Division of Probation form in the editor.
2. Begin by entering the date at the top of the form. This is essential for tracking your submission.
3. Fill in your agency name, address, city, state, and ZIP code in the designated fields. Ensure accuracy to avoid processing delays.
4. Provide contact information including a contact name, phone number, and email address. This will facilitate communication regarding your application.
5. Indicate the type of agency by checking the appropriate box (Corporation, Individual, Proprietor, or Other).
6. Answer whether you are an approved Medicaid funded provider by selecting 'Yes' or 'No'.
7. List any other insurance accepted and specify if you offer tele-therapy or in-person services.
8. Check all applicable treatment/services your agency can provide from the provided list.
9. Complete the section for therapist/polygraph examiner names and license numbers as required.
10. If applicable, list additional locations and contact details for your agency before submitting.

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