CDCP Employer Application

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IRIS Participant, Family Care SDS, and CLTS Participants ONLY: Please enter your first name and last name as the Agency/Facility Name OR if you do not wish to have your name listed for privacy reasons, please enter the last four digits of your phone number + your zip code + CDCP (example: Phone number 123-4567, zip code 54301 = 456754301CDCP). We do not publicly share your information with CDCPs without your permission.







If your entity/company does not have a provider license number, write 'NONE'















Legal Entity Information


Owner, licensee, or legal entity used for licensure, certification, or registry








For help with the CDCP Training Registry, please contact us at:
Phone: 920-465-2315 or Email: cdcp@uwgb.edu

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Please enter the information of the contact person, and one alternate contact person, at your agency or facility below.