Provider Application
Please complete all sections of this application.
Step 1. Complete and save the Mainspring Academy Provider Policy.
(Laptops/Desktop Only)
VIEW PROVIDER POLICY>
Step 2. Upload your Provider Policy.
Provider Application
Step 3. Upload your Level 2 Background Check
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.
Level 2 Background Check
Step 3. Upload a Recent Headshot
Required. Please upload an appropriate clear and recent headshot for our provider records. Many outside agencies provide services at Mainspring Academy. This will assist our rotating office staff in identifying you.
Headshot Provided
Step 4. Ensure Parents Have Completed, Signed, and Submitted the Permission for In-School Services Form
VIEW PERMISSION FOR IN-SCHOOL SERVICES FORM>
*If the parent has not already submit this to the School, you may upload completed and signed Parent Permission forms here.
Upload Signed Parent Permissions
Step 5. (ABA Case Managers Only) Upload a copy of client treatment plan(s)
Client Treatment Plan(s)
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 by the school's Director of Programming.
Provider Agreement Accepted
eSignature
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