Florida Child Care Resource & Referral Provider Update Form
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1 Florida Child Care Resource & Referral Provider Update Form Name of Person filling out form: Date form was completed: Do you wish to have your program referred to families seeking child care listings from the Child Care Resource & Referral Office: YES NO Please return form to us by: Date: Early Learning Coalition of Sarasota County Child Care Connection 2886 C Ringling Blvd Sarasota, FL ext (fax) Family Child Care Home or Business Name: CCR&R Name: (as it appears on License) sarasota.org Address: City: Mailing Address: Zip Code: same as above Telephone Number: Alternate/Emergency Telephone Number: Fed. ID No./ SSN: Registration/License#: Director Name: Fax#: Family Child Care Home Only: Do you want your house number and street name to appear on referral lists to families? YES NO 1. ACCREDITATION - Are you accredited by any organization? (Check all that apply) G Seal Accreditation Religious Exempt Accreditation Accred. Professional Preschool Learning Envir. (APPLE) Assoc. Christian Schools International (ACSI) Assoc. Christian Schools International (ACSI) Assoc. Christian Teachers & Schools (National) Assoc. Christian Teachers & Schools (ACTS) Assoc. Christian Teachers & Schools Council on Accreditation (COA) Christian Schools of Florida Montessori School Accred. Commission (MSAC) Church Avenue Academy National Accreditation Commission (NAC) Church of God Association of Christian Schools Natl. Assoc. for the Education of Young Children (NAEYC) Early Childhood Christian Education Association National Association for Family Child Care (NAFCC) Florida Assoc. of Christian Schools & Colleges, Inc. National Council for Private School Accreditation (NCPSA) Florida Catholic Conference National Early Childhood Program Accreditation (NECPA) Florida Kindergarten Council National School-age Care Alliance (NSACA) Florida Coalition of Christian Private Schools Association Southern Association of Colleges & Schools (SACS) Fl League of Christian Schools United Methodist Assoc. of Preschools (UMAP) Green Apple Association of Christian Schools National Accred. Council for Early Childhood Prof. Prog Light of the World Christian School Miracle Faith Center Narrow Door Pentecostal A COPY OF YOUR CERTIFICATE IS REQUIRED National Association for Christian Education IN ORDER FOR ACCREDITATION TO BE LISTED. Natl. Assoc. for the Education of Young Children National Lutheran School Accreditation (FL-GA district) Effective date on Certificate / / New Beginnings Christian Center Accreditation (NBCCA) Expiration date on Certificate / / Nicene Schools International Papa Goose Network of Christian Nursery s 2. AFFILIATION - Not For Profit Yes No Sonshine Association of Christian Schools 4/12/2011 Agency for Workforce Innovation s Office of Early Learning 1
2 3. CURRICULUM - Which of the following curriculum does your program use? (Check all that apply) Beyond Centers & Circle Time Wee Learn Other (list) Creative Curriculum DLM Early Childhood Express Doors to Discovery Galileo High Reach(approved for family child care providers) Reggio Emelia approach (must be used by teachers trained in this approach Active Learning Series School Readiness Express DECA Kindness Curriculum I love You Rituals-Becky A. Bailey Optimistic Classroom 4. VACANCY/ENROLLMENT/CAPACITY: What is your total licensed capacity? (number of children you are licensed to care for) What is your actual capacity? (most number of children you choose to care for) In the chart below please indicate: The number of vacancies available at the present time in each age group The actual number of children enrolled (combining both full & part time children enrolled) in each age group The maximum number of children you offer services to by age group The number of children enrolled in VPK by age group (either 4 or 5 years ) Enter results by number of children by age group: Infant 1 year 2 year 3 year 4 year 5 year Elementary School Age (B/A Only) * Middle School Age (B/A Only) * Number of Vacancies at the present time: Actual number of children enrolled: Maximum number of children you will accept Number of children enrolled in VPK (not included in above total) * If a Private School do not include the private school students in the counts 5. ENVIRONMENT - Describe your program s setting. (Check all that apply) Accommodates German Negotiated Rate Sliding Fee Scale Allergies Bilingual Greek Smoke Free Facility Spa on site Chinese Green Certified Building No TV School Readiness Agreement Cat Habla Espanol Provider participates in Teen Parent Program Operation Military Child Care Corporate Hebrew Outdoor Play United Way Creole Italian Parent Co-op Vietnamese Diapers provided Limited English Pets Video Monitoring Dog Large FCCH Pool on Site Wheelchair Accessible English Limited Spanish Portuguese Web Cam on site Employer Contract Licensed School Age SR Private School Other (list below) Agreement Exempt School Age Provides Meals Russian SR Agreement French Medicaid Provider Fluent Spanish Fenced Yard Military Scholarships Available Filipino Multi Child Discount Sign Language Faith-based No English Sick Child Care 4/12/2011 Agency for Workforce Innovation s Office of Early Learning 2
3 6. ADDITIONAL FEES - Please list all additional fees that your program charges. Description Amount How often is this fee charged? (See Codes Below) Activity $ Annual $ Application $ Dance lessons $ Xtra Curricular Activities $ Field Trips $ Gymnastics lessons $ Holiday $ Insurance $ Late pick-up $ Late payment $ Meals/Snacks $ Music lessons $ Overtime/Early Drop-off $ Returned check $ Registration $ Summer Camp $ Supplies/Materials $ Swimming lessons $ Transportation $ Other: $ Is this fee per child or family? (C/F) Frequency Codes: Both Ways; Every 10 minutes; Half Hour; Hourly; Minutes; Every 5 minutes; Yearly; Every 15 minutes; Monthly; One Time; One Way; Weekly; Daily. 7. MEALS - What meals does your program provide? (Check all that apply) Afternoon Snack Lunch Special Diet Requests Breakfast Morning Snack USDA Food Program Bring Own Lunch/snacks Parent Supplies Formula Dinner Provides Formula 8. PROGRAM PARTICIPATION - Is your program/facility a? (Check all that apply) Child Care Center Military (on base program) Summer Camp Family Child Care Home (FCCH) Nanny/Au-pair VPK School Year program Head Start Playgroup VPK Summer program Large FCCH School Age Program 4/12/2011 Agency for Workforce Innovation s Office of Early Learning 3
4 9. RATES: In the table below enter the advertised rates (private pay rates) your program charges. Do not include voucher/subsidy rates, sliding scale rates, employee discounts or any other discounted rates. Only complete the rate type for each age group that you offer. You must submit a public rate sheet as well. If you do not want to fill out the rates below, please write in See Attached Rate Sheet RATES ENTER BY AGE GROUP (see note above) Enter Rate by Age of Children Infant 1 year FULL- TIME Circle frequency: Weekly/Monthly/Annually FULL time VPK WRAP Circle frequency: Weekly/Monthly/Annually PART-TIME Circle frequency: Weekly/Monthly/Annually PART TIME VPK WRAP School Age BEFORE SCH. School Age AFTER SCH. School Age BOTH BEFORE & AFTER SCH. SUMMER 2 year 3 year 4 year 5 year Elem School Age Mid School Age 10. SCHEDULE - What days of the week does your program operate? (Check all that apply) Sunday Monday Tuesday Wednesday Thursday Friday Saturday What are your hours of Open Time: Close Time: operation? circle AM or PM circle AM or PM What are the ages you serve? From (minimum age): Sample: 2 months to 6 years To (maximum age): Years 11. ENHANCED SCHEDULE - Does your program provide the following schedule? (Check all that apply) 24-Hour Care Full Time Rotating After School Full Year Summer Only Both Full & Part-Time VPK Wrap Care Follow local School System Weather Days Before School Morning School Year Drop In Care Open if Safe Weather Vacation/Holiday Emergency/Temp. Care Overnight Weekend Care Evening Care Part Time Respite Care 4/12/2011 Agency for Workforce Innovation s Office of Early Learning 4
5 12. ENHANCED SERVICES - What other services does your program offer? (Check all that apply) Computers Health/Social Services Outdoor Sports Training/experience with children with developmental delays Art/Crafts Homework/Tutor Small Group Size Training/experience with making environmental accommodations for children with special needs Family Involvement Kindergarten Class Swim Lessons Therapeutic Services Field Trips Music Lessons Training/experience with children with autism spectrum disorder Gymnastics/Dance Lessons On-site Screenings 13a. Total number of staff that work directly with children in care. Training/experience with children with behavioral challenges Other (list here) 13b. STAFFING - Enter below the number of staff that work directly with children in care that have any of the following qualifications/degrees/courses/credentials/training: # FCCH completed 2 nd Helping course # Provider/staff has Early Literacy training # Provider/staff has AA/AS Degree non-child related # Provider/staff had first aid training within past 2 years # Provider/staff has AA/AS Degree in early childhood # Provider/staff has High School Education/GED # Director Credential Advanced # Provider/staff has MA Degree non-child related # Director Credential Foundational # Provider/staff has MA Degree in early childhood # Provider/staff has BA/BS Degree non-child related # Facility has medical staff onsite # Provider/staff has BA/BS Degree in early childhood # NAFCC FCCH Observer Trained # Provider/staff has CDA credential # Provider/staff does not have High School/GED # Provider/staff has CDA equivalency # Special Needs Training (describe) # Provider/staff had CPR training within past 2 years # Provider/staff has VPK Director Credential # Provider/staff has Doctorate 14. SUBSIDIES - Does your program currently serve children who receive child care subsidies (School Readiness) or financial assistance to pay for their care? Yes No School Readiness Agreement Voucher-Other Agencies (list) 15. SUBSTITUTION POLICY - What is your programs substitution policy? (Check all that apply and list schools below) Friend Substitute Pool Spouse Relative Other Substitute (list here): 16. TRANSPORTATION - Do you or the school provide transportation? (Check all that apply) From school to site (list school names) From site to home To school from site (list school names) Near public transportation To site from home In walking distance to school (list school names below): By school bus or van 17. For each of the following positions, please enter the average salary or hourly wage and the average number of hours worked per week Position Hourly/Salaried position? Average Salary/Wage Average number of hours worked per week Center Director/FCCH Operator Head or Lead Teachers Teachers 4/12/2011 Agency for Workforce Innovation s Office of Early Learning 5
6 Teacher Assistants/Aides Other (please list) 18. Are any of the following benefits available to staff? Benefit Available to full-time staff? Available to part-time staff? Not available to any staff? Health Insurance Dental Insurance Disability Insurance Retirement Plan Paid vacation Paid sick time/personal days Reduced rates for children of staff Financial assistance to cover courses (college courses) Financial assistance for inservice workshops, conferences, etc Paid parental leave Other (please list) 19. What are the most common reasons staff stated for leaving? (Check all that apply) Pay Benefits Conflict with co-workers/employer Relocation Family issues Burn-out Better job opportunity Other: Lack of career ladder within the child care field outside of the child care field 20. What are the most common reasons staff have stayed? (Check all that apply) Pay Benefits Commitment to teaching/joy of teaching Family friendly workplace Managerial support Good working relationship with coworkers/employer Other: 21. How many times a month, on average, is your program short a teacher? Less than 3 14 to 16 4 to 6 17 to 19 7 to 9 Over to 13 How many classrooms in your program? Comments/Questions: Thank you for your cooperation in gathering this important information. You may contact this office at any time to update your information. We are available to answer any questions you might have by calling Karen Massa at ext /12/2011 Agency for Workforce Innovation s Office of Early Learning 6
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