TLEA Extension Request Form

In order to be considered for a 90 day extension, please complete the information below.

Please note that the Professional Standards Committee will need to vote formally to approve your agency's extension. This vote will take place during the next scheduled meeting of the committee.

After the committee has voted on your extension, you will be notified of the decision by email with formal letter attached.

If your agency's extension is approved, at the end of the assigned 90 days the agency will need to be prepared for a formal file review and onsite. If the agency is unable to meet this deadline, the accreditation manager and agency CEO may request a second extension to be considered by the Professional Standards Committee. A second extension request will only be considered for extreme circumstances or hindrance to the accreditation process.

Name of Agency *

Name of Agency CEO *

Agency CEO Email *

example@example.com

Name of Accreditation Manager *

Accreditation Manager Email *

example@example.com

Does your agency currently have a mentor?*

Date of last TLEA award*

Please provide a brief description outlining the reason you are requesting a 90 day extension. *

Signature of Accreditation Manager *