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 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.
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. This is required, even for therapists that have previously provided services at Mainspring. If you have not already submitted a headshot in the past, please submit one.
Headshot Provided
Step 4. (ABA Case Managers Only) 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 Director of Programming. You must await this approval and start date. There may be a 24-48 hour processing period. If in the future, case managers are requesting for providers to observe only, they must comply with the same process.
Provider Agreement Accepted
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