Service Provider Application {FamLaw-132}

FamLaw-132 - SERVICE PROVIDER APPLICATION. This form is used in the Superior Court of California, County of Contra Costa. It is designed for individuals or businesses who wish to offer specific services to the court, such as parenting programs, counseling, anger management, supervised visitation, or child custody evaluation. The applicant must complete the form with their personal or business information, including name/business name, address, phone number, email, and website (if applicable). They are also required to provide their professional license number and type of license (e.g., LMFT, LCSW) issued by the Board of Behavioral Sciences. Additionally, the applicant needs to include their fee schedule as they would like it to appear on the provider list, along with the location(s) where they provide services. Depending on the type of service they offer, the form may require additional details such as the length of the program for parenting/co-parenting/anger management/substance treatment providers or whether they have a dedicated building for supervised visitation. The applicant must sign the form to indicate agreement and understanding that the information provided may be released to the public. www.FormsWorkflow.com