Name		Date
Address		License
		Licensor
Phone:

Please complete the entire form. If conditions are met you will be directed to the proper paperwork.

Variance requests, along with a completed checklist, need to be submitted to Blue Earth County for review at least 30 days in advance. Blue Earth County will not discuss variance requests until all paperwork has been submitted and reviewed.

To view a pdf of the full Variance Policy and Procedures click here.

Question	Condition Met	Condition Not Met
This variance request is not retroactive.	Yes	No
I have been licensed for at least one year.	Yes	No
The variance is for 90 days or less.	Yes	No
I have not had a variance within the past 12 months.	Yes	No
I will not be caring for more than 3 infants at any time.	Yes	No
The variance request is for only an age or capacity variance and not both.	Yes	No
A variance cannot be avoided by changing my license class (moving to a C3 is exempt).	Yes	No
I do not have an outstanding correction order.	Yes	No
I do not have an active correction order regarding: supervision, corporal punishment, infant safe sleep or over-capacity.	Yes	No
Neither I nor any household member are currently under investigation by child protection or licensing.	Yes	No
I do not have a pending, existing or appealing a negative licensing action or it has been more than 3 months since my negative licensing action ended.	Yes	No
I will develop alternative measures to help ensure safety of all children.	Yes	No
I have the appropriate equipment to accommodate the numbers of children I will have in care.	Yes	No
I have emergency transportation plans for all children in care.	Yes	No
If I have a child with special needs in care, I have taken measures to ensure their needs are met during the variance period.	Yes	No