Please complete the application and the Facility Status Survey. Your agency will be invoiced for software and accreditation fees and sent an agreement. Please contact your Program Manager for additional information at 1-800-558-0218.

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* 1. Agency name (as it should appear on your accreditation certificate)

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* 2. What services does your agency provide?

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* 3. Mailing address

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* 4. Physical address (if different from above)

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* 5. County

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* 6. Phone number

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* 7. Chief Executive Officer

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* 8. CEO email address

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* 9. Accreditation Manager (AM)

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* 10. AM email address

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* 11. AM Phone number

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* 12. Agency/Facility website

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* 13. Number of authorized pretrial services program employees

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* 14. Number of authorized probation services program employees

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* 15. Service area total population

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* 16. How is your service area determined?

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* 17. Is your agency currently accredited by other organizations?

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* 18. If yes to Question 17, please indicate accreditation below.

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* 19. Does your agency have a current copy of the FCAC Pretrial and Probation Standards Manual?

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