Bcal 1074 Form – Fill Out and Use This PDF

Bcal 1074 Form PDF Details

This 2-page document is used by organizations to apply for or renew a Child Caring Institution (CCI) license in Michigan. Submitted to the Michigan Department of Health and Human Services (MDHHS), the application ensures that child care facilities meet state standards for safety, program quality, and staff qualifications.

What the Application Covers

Applicants must provide information in these key areas:

• Facility details: Name, address, capacity, and physical setting (urban, suburban, or rural).
• Children served: Age ranges, sex, and whether the facility is a therapeutic group home or a standard CCI.
• Program types: Secure (S-Secure), non-secure, short-term (S-Short), open, treatment (T-Treatment), and other program categories.
• Organizational information: Government or non-government status, accreditation status, water and sewage systems, and behavior management room details.
• Staff credentials: Criminal history checks for all employees who have contact with children, confirming compliance with Michigan law.

The form requires certification that all employees comply with Michigan's Child Care Organizations Act (PA 116 of 1973 or PA 238 of 1975). Operators must keep a copy for their records and return the original to MDHHS upon submission.

Related Michigan Child Care Forms

Michigan child care operators commonly use several related licensing documents. The BCAL 1326a Form and the MDCH BCAL 3305 Form address related licensing requirements. The BCAL 3266 Form covers foster family home licensing. Visit the Child Care Incident Report page for incident documentation forms.