ALC Licensure Survey Your Community Name(Required) Name of Executive Director or Administrator(Required) Has your Executive Director's Name or Contact Information Changed Recently?(Required) Yes No If this information has changed recently, please provide an updated phone number for your Executive Director or AdministratorIf this information has changed recently, please provide an updated email address for your Executive Director or Administrator How many ALC (Social Model) Licensed Apartments Do/Will You Have?(Required)How many ALC-BH Licensed Apartments Do/Will You Have?(Required)How many ALC-DC Licensed Apartments Do/Will You Have?(Required)If your Personal Care Home will not convert to ALC Licensure, please tell us how many licensed Personal Care apartments you have.What is the total number of licensed apartments at your community?(Required)
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