To acquire a RCIA Permit, you must first pass the Minimum Qualifications .
The Applicant Information section on the form should show the name of the entity requesting the permit and the mailing address for the entity.
All required fields are denoted with a red asterisk (*)
All required fields are denoted with a red asterisk (*)
First two lines are reserved for the name of the RCIA. The third line is reserved for the direction (i.e., next right/left, x miles, etc.).
If the files are primarily electronic and you have them, then indicate that you will attach them; otherwise, indicate that you will mail them.
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Select the Cancel button to exit to the main menu without saving your information.
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Select the Reset button to erase your information and start again.
Last modified date: 08/28/2002