Maryland State Department of Education

Maryland State Department of Education

Division of Educator Effectiveness

Nonpublic School Approval Branch

200 West Baltimore Street

Baltimore, Maryland 21201

(410) 767-0409

CERTIFICATION OF COMPLIANCE WITH THE CHILD ABUSE AND NEGLECT REPORTING LAW

Family Law Article, Title 5, Subtitle 7. Child Abuse and Neglect requires every health practitioner, educator, human services worker, or law enforcement officer who has reason to believe that a child has been subjected to abuse or neglect, report such abuse or neglect to the appropriate authority.

I hereby affirm that Name of Legal Authority is in compliance with Family Law Article, Title 5, Subtitle 7. Child Abuse and Neglect. I further affirm that all personnel of the educational program known as Name of School or Educational Program located at Address (including city, zip code and county) have been made aware of the requirements of this law.

CERTIFICATION OF COMPLIANCE:

This form must be signed by the Chief Officer of the legal authority responsible for governing and operating the school.

I hereby certify that the information provided herein is true and correct.

(Print Name) (Title)

(Signature) (Date)

Revised 08.08.13/ac