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BAS Assessment Request Form
BAS Assessment Request
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Directions: Please complete this form to request that a valid and reliable assessment tool that will measure overall quality of the program. The cost of this assessment is $300, which includes an interview and a written report, completed within 3 business days of the visit. Please complete this form in its entirety.
What environmental rating scale do you need?
*
Business Administrative Scale
Cost for BAS $300.00
How will you use the BAS results in your program?
*
Please give three (3) dates you would like to hold for the assessment.
Name
*
First
Last
Email
*
Phone
*
Address
*
Street Address
Address Line 2
City
ZIP Code
Hours of Operation Start Time
*
:
Hours
Minutes
AM
PM
AM/PM
Hours of Operation End Time
*
:
Hours
Minutes
AM
PM
AM/PM
I agree to terms and service
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I acknowledge payment will be paid directly to the United Way of Connecticut. The cost of this observation is $300, which includes a 1-hour interview, review of documents and a written report, completed within 3 business days of the visit.
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