Create Provider Account - AFH Workforce Academy

Eligibility Check

Account Details

ProviderOne List

Training Agreement

Check Your Eligibility

You must meet all of the requirements below to continue.
If any requirement does not apply, you will not be able to proceed with the application.

Eligibility Requirements

Please confirm that all of the following requirements apply to your facility.

Licensed AFH Provider You hold a current license to operate an Adult Family Home in Washington State At least one Medicaid-occupied bed Your home currently has at least one Medicaid-occupied bed. ProviderOne list ready You have access to a ProviderOne list for your current caregivers.

AFH Provider Information

AFH Business Name*

AFH License Number*

Contact Person Name*

Phone Number*

Email Address*

AFH Address*

Referral Source*

AFH ProviderOne list

Upload ProviderOne list*

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AFH Provider Training Agreement

ADULT FAMILY HOME WORKFORCE ACADEMY
TRAINING ENROLLMENT AGREEMENT

This Training Enrollment Agreement ("Agreement") is entered into as of the date indicated below between the Adult Family Home Workforce Academy ("Academy") and the undersigned Adult Family Home Provider ("Provider").

1. PURPOSE

The Academy provides state-approved training programs to prepare caregivers for employment in Adult Family Homes. The Provider agrees to enroll eligible caregiver(s) in the training program(s) selected in this application.

2. PROVIDER RESPONSIBILITIES

2.1 Ensure all information provided in this application is accurate and complete.
2.2 Ensure the caregiver meets all eligibility requirements prior to enrollment.
2.3 Ensure the caregiver attends and completes all required training sessions.

3. ACADEMY RESPONSIBILITIES

3.1 Provide state-approved training programs.
3.2 Issue certificates upon successful completion of training.
3.3 Maintain records of training completion.

Contract Signature

By signing below, you confirm that all information provided in this application is accurate and complete, and that you have read and agree to the Training Enrollment Agreement.

Signature (type your full name)*

Date*

Your typed name serves as your legal signature.