Agency Name 

Mailing Address

City    Zip    County

Physical Address (if different from above) 

City       Service Area Total Population

Does your agency/facility have a web-site? 

Chief Executive Officer/Administrator      Email 

Phone   Fax

Accreditation Manager      Email 

Phone   Fax

Authorized Pretrial Program Staffing:       Certified        Civilian 

AGENCY STATUS SURVEY

Your answers to the following questions will assist Commission staff in determining
the status of your facility's readiness to begin the state accreditation process.
 

1.)   Has an accreditation manager been assigned?     Yes, full-time     Yes, part-time     No
         if yes, please provide name and contact number(s) on the application

2.)   Have any additional staff members been assigned?      Yes      No
         if yes, please provide names and contact numbers below.
        

3.)   Does anyone on staff have accreditation experience?     Yes      No

4.)   Have any current agency members attended Accreditation Manager training?
       Yes           No
       If yes, Attendee(s) and date(s)
      

5.)   Have any current agency members attended Assessor Training?
       Yes           No
       If yes, Attendee(s) and date(s)
      

6.)   Has anyone in your agency attended a FCAC Commission meeting or a Florida Police Accreditation Coalition (FLA-PAC)
       accreditation conference?
       Yes           No

7.)   Is your agency a member of the FLA-PAC?
       Yes           No

8.)   Have you been in contact with Executive Director Kim Bogart, or your agency's Program Manager (Jana Paulk for North Florida, Debbie   
       Moody for Central Florida, or Joe Suldo for South Florida) to discuss the application process?
       Yes           No

9.)   What influenced your CEO's decision to apply for state accreditation?

10.)  How did you first hear about the state accreditation process?

11.)  Have you been in contact with any accredited agencies in your area?
       Yes           No
       If yes, Please explain