Provider application

Apply to join as a provider for families.

Providers can list education, care, nursing, therapy, arts, music, special support, and other services. Real onboarding should include secure storage, written consent, verification, and review before profiles go public. Provider applications are free during launch; background checks are $40.00 when required. Future monthly subscriptions can be canceled at any time before the next billing cycle.

Applicant Type Are you applying as an individual or organization? Organization name, if applicable Organization website Organization logo Organization or program description

Basic Information Full legal name Preferred display name Email Phone City and state ZIP code States served Website or professional profile Profile picture for provider network Service or professional photo

Services Offered Service description

Credentials and Experience Years of experience License or certification type License or certification number Issuing state or agency Education, training, and relevant skills Languages spoken

Organization Verification Primary organization contact Contact title Organization email Organization phone Business license, nonprofit ID, or registration number Upload organization verification document Staff screening process

References Reference 1 name Reference 1 contact Reference 1 relationship Reference 2 name Reference 2 contact Reference 2 relationship Reference 3 name Reference 3 contact Reference 3 relationship May Hope contact these references?

Background Check and Consent

Background checks must be handled through a compliant screening provider. This draft does not run a check. Written authorization and required notices should be completed before any third-party report is ordered.

Background check fee: $40.00

Hope plans to use SentryLink for provider background screening. The provider background check fee is $40.00 and includes the screening cost plus processing and bank charges. It should be paid only after Hope gives the next step and required written authorization instructions.

Background check consent required

Hope will not request a third-party background check without the provider’s written authorization. Providers must review the disclosure, give consent, and complete any required SentryLink authorization steps before screening begins.

Have you completed a background check in the last 12 months? Background check completion date Screening company or agency Upload background check proof

I agree to identity verification. I agree to license or credential verification when applicable. I am willing to complete a background check process. I understand Hope must receive my written consent before requesting a background check. I consent to completing the SentryLink background check process if Hope requires it. I understand the provider background check fee is $40.00. I understand uploaded proof must be reviewed before any profile status is shown. I understand false information may prevent approval.

Background check notes