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Affiliate Forms



To remain an official CDAPP Sweet Success Affiliate, the following forms must be filled out and returned to the CDAPP Sweet Success Resource and Training Center annually.  Please use the online submission form to send your information.  If you choose the Word Document version of either form you may print and fax (844-653-6198) the Word Document or email it to  Feel free to call 714-921-9755 if you have any questions.


Two Forms Due: Thursday, January 31, 2019 
Updated Forms will be posted mid December 2018. For examples of previous year forms see below:
Form 2: 
Annual Affiliate Survey with your 2017 Client Data
-Can fill out in more than one sitting if using same computer.
-Highly recommended - less time consuming due to built in drop-downs.
-Answers can be typed in and saved to your personal computer or printed and hand-written
-For Word Document Version Only - If you have more than 5 staff persons to report their Staff Education, please use the Supplement Staff Education List in addition to the survey.

Before filling out the survey have these items ready:
  1. A list of all your affiliate sites, addresses, and contact information
  2. Staff education information (e.g. webinars attended, license numbers, emails for all staff seeing patients)
  3. Aggregate Client Data for all your sites




Other Forms

If you would like to apply to become a CDAPP Sweet Success Affiliate, please fill out and submit the following:
CDAPP Sweet Success New Affiliate Application Form

If you wish to collect your own data on your patients, here is a sample data collection form for your use.
CDAPP Sweet Success Individual Affiliate Data Form (Word)

If you would like a quick summary of the types of client categories, services usually rendered, and CPT codes most often used when billing for these services, see the document below.  (This document is intended for use with non-CPSP payers.)
Example: Client, Length of Visit, Service, CPT Code

How to Contact Us

CDAPP Sweet Sucess Resource & Training Center
22875 Savi Ranch Parkway Suite I

Yorba Linda, CA 92887

O: 714-921-9755
F: 844-653-6198

email CDAPP Sweet Success

Funding is provided by Federal Title V Block Grant Funds through the California Department of Public Health (CDPH), Center for Family Health (CFH), Maternal, Child and Adolescent Health (MCAH) Division.