Application Process

Confirm You're Ready to Enroll Your Caregiver

Most providers can complete this in under 2 minutes.

AFH Eligibility

Licensed AFH provider At least one Medicaid OCCUPIED bed AFHTN Orientation completed (past year) ProviderOne list ready

Caregiver Eligibility and Documentation

Caregiver applicant has worked at least 8 hours at this home (these 8 hours must be within the time frame from the date of hire) Government-issued ID ready Social security card ready Eligible to work in the U.S. (I-9) Passed background check + fingerprinting Signed job offer ready

AFH Provider Information

AFH business name*

AFH license number*

Contact person name*

Phone number*

Email address*

AFH address*

Caregiver Applicant Information

Full name (as on ID)*

Phone number*

Email address*

Date of birth*

Confirm email address*

Mailing address*

Caregiver Applicant Information

Government-issued ID number*

Upload ID image*

Click to upload ID imageSupported formats: JPG, PNG, PDF (Max 5MB)

SSN*

Upload SSN Card*

Click to upload SSN Card imageSupported formats: JPG, PNG, PDF (Max 5MB)

Caregiver Applicant Information

Hire/intend to hire date*

Gender*

Race/ethnicity*

Highest level of education completed*

Disability*

Military Veteran*

Caregiver Eligibility Attestation

I attest that the caregiver has provided documentation meeting I-9 employment eligibility requirements to work in the United States

I attest that the caregiver has successfully completed a background check and fingerprinting and is eligible to work in an Adult Family Home in Washington State.

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)*

Your typed name serves as your legal signature.

Date*

Training Information

Referral Source*

Can the Caregiver take the training online?*

What date can the Caregiver start training?*

Does the Caregiver have previous healthcare experience?*

If yes, please describe experience.

Does the Caregiver have any other certificates? If yes, please list below.

Select Training

Select training language*

Select training school region*

Does the caregiver need a caregiver license*

Yes No

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)*

Your typed name serves as your legal signature.

Date*

Application Submitted Successfully

The caregiver's training application has been received.
A confirmation email with the application details has been sent to you.

What happens next:

• The caregiver will receive a contract via email that must be reviewed and signed.
• Our team will review the submitted application and documentation.
• Once everything has been evaluated, we will notify you of the enrollment status.

This process typically takes 1-2 business days.

AFH Training Application

AFH Eligibility

Caregiver Eligibility and Documentation

1. PURPOSE

2. PROVIDER RESPONSIBILITIES

3. ACADEMY RESPONSIBILITIES

Application Submitted Successfully