Provider Application
Please complete all sections of this application.
Step 1. Review, complete and save the Mainspring Academy Provider Policy and Personal Appearance Policy
(Laptops/Desktop Only)
VIEW PROVIDER POLICY>
REVIEW PERSONAL APPEARANCE POLICY>
Step 2. Upload your completed Provider Policy (Required)
Provider Application
Step 3. Upload your Level 2 Background Check (Required)
Level 2 Only. The Florida Department of Law Enforcement Level 2 Criminal History Record Checks is used in Florida Statutes to convey the method of the criminal history record check and the extent of the data searched. Level 2 describes a state and national fingerprint-based check and consideration of disqualifying offenses and applies to those employees designated by law as holding positions of responsibility or trust. Background checks must be up-to-date. If you submitted an UP-TO-DATE background check in the 2023-2024 school year, you will not have to resubmit for the 2024-2025 school year. Please note that Mainspring Academy can request an updated Level 2 Background check at any time and agencies must provide these within 3 business days upon request in order for the provider to continue services at the school.
Level 2 Background Check
Step 4. Upload a Recent Headshot (Required)
Please upload an appropriate clear and recent headshot for our provider records. Headshots with heavy filtering, sunglasses, hats, or any objects obscuring the provider's face will not be accepted. Many outside agencies provide services at Mainspring Academy. This will assist our rotating office staff in identifying you. If your Provider Application was approved in the 2023-2024 School Year, you do not have to resubmit your headshot until the 2025-2026 School Year. Please note that Mainspring Academy can request an updated headshot at any time and agencies must provide these within 1 business day upon request in order for the provider to continue services at the school.
Headshot Provided
Step 5. (ABA Case Managers Only - Required) Upload a copy of client treatment plan(s)
Client Treatment Plan(s)
Failure to submit required items above will result in an incomplete application and a delayed processing time. Therapists may not provide services at Mainspring Academy until the school has received a Permission for In-School Services form from the student's parent. In addition,
services at Mainspring Academy may not be provided until this application is reviewed and approved via email by the school's Operations Coordinator, Laney Gonzalez. You must await this approval and start date. There may be a 24-48 hour processing period. If you do not receive an approval email, you are not approved to begin.
If in the future, case managers are requesting for providers to observe only, they must comply with the same process.
Provider Agreement Accepted
eSignature
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