NCCDP Application Request for Certified Memory Care Neighborhood Commendation

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Application

Please complete the form below. Upon completion of the form you will be directed to a page with the application form.

* - required fields

Your First Name*

Your Last Name*

Your Position*

Contact eMail*

Name of Facility*

Name of Corporation*

Address*

City*

State*

Zip/Postal Code*

Business Phone*

Name of Secure Unit

How many beds on secure unit?

How did you hear about us?*

Message/Comment

DISCLAIMER

The MCNC Memory Care Neighborhood Commendation Certification indicates that the facility in question has complied with the criteria set by the National Council of Certified Dementia Practitioners for such Certification. It does not indicate that the facility has or will meet the criteria for compliance with governmental requirements.

The Memory Care Neighborhood Commendation Certification indicates that the facility in question has complied with the criteria set by the National Council of Certified Dementia Practitioners for such Certification. The certification is based on information provided by the facility and a one time visit by NCCDP. At most, the Certification indicates that the facility appeared to be in compliance with NCCDP’s criteria for Memory Care Neighborhood Commendation Certification on the date of the inspection. There is a renewal process but no site inspection occurs unless the renewal application suggests a need for an on site inspection. Accordingly, NCCDP disclaims all liability for and knowledge of the compliance of the facility with NCCDP requirements after the date of such visit by NCCDP to the facility.