New Jersey Summer Enrichment and Literacy Program Application. Applicant Contact Information

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1 New Jersey Summer Enrichment and Literacy Program Application Applicant Contact Information Program Name EPPIC ID# Program Phone Program Address Director/Owner fax License # Expiration Date NAEYC Accredited Y N Head Start Program Y N DOE Pre-school Program Y N Licensing Capacity Hours of Operation Enrollment Information (indicate reporting month 2013) Current Enrollment # of Infants # of Toddlers # of Preschoolers # of School Age Full Time Part Time Total # of children receiving subsidy Proposed number of Children to Enroll # of Preschoolers # of Classrooms Program and Staffing Information # of Lead Teaching Staff Full Time Part Time Total # of Certified Teachers Do you currently have a Master or Certified Preschool Teacher? Y N Full Time or Part Time Are you currently using a curriculum Y N Which One: Are you currently using the DOE s Early Learning (Preschool) Standards Y N 1 NJ Department of Human Services New Jersey Summer Enrichment and Literacy Program

2 Instructions: Please follow the submission instructions. Failure to do so may result in disqualification. Do not modify the form. 1. Use 11 pitch, Times New Roman to reply (Times New Roman is used in these instructions) 2. Where a line has been provided, simply insert the information. 3. Submission can be done electronically, faxed or by certified mail. 4. Please submit all necessary documents that support the application. 5. Adhere to all submission deadlines. Narrative Please provide detailed information to describe how your center will prepare for and implement the New Jersey Summer Enrichment and Literacy Program. Use or Familiar with the Early Learning Standards and Literacy Component Programs are required to become familiar with the Early Learning Guidelines and Standards, which will include a literacy component. It is expected that programs use it as a resource to promote learning and development in the classroom. Technical assistance on the Early Learning Guidelines and Standards is available through the Child Care Resource and Referral agencies. Please indicate if you are interested in TA. Yes or No Classroom Size and Teacher Requirement Classroom Ratio: Centers administering the program will be required to maintain a classroom ratio not to exceed the guidance listed below. Please provide a draft staffing plan for the number of children you propose to serve. Each center must have a certified teacher for each funded classroom. 3yr old classroom ratio (2) early childhood staff: 18 children 4yr old classroom ratio (2) early childhood staff: 20 children 5yr old classroom ratio (2) early childhood staff: 20 children Mixed-age classroom ratio with 3 year old children (2) staff: 18 children Mixed-age classroom ratio with 4 and 5 year old children (2) staff: 20 children Participate in USDA Food Program or commitment to enroll New Jersey has a food program which is advantageous to eligible families. Is your program currently participating in this program? Yes or No (Attach your current nutrition policies and practices for breakfast, lunch and snack). If not in the USDA program, indicate commitment to provide healthy snacks/meals. Nutrition and physical activity are key components to early childhood development. Describe how your program will ensure that adequate physical activity and nutritious snack/meal options will be implemented into the daily program agenda. You can access information at 2 NJ Department of Human Services New Jersey Summer Enrichment and Literacy Program

3 Family Engagement There will be a minimum offering of two family-focused activities required during the eight to tenweek session. One event must entail conducting the Strengthening Family Pre/ Post Survey and another type of Family Event or Workshop. Provide some initial ideas or topics for your program related family development activities you have found to be successful. Active Membership in PINJ Registry Participating programs are required to have their early childhood staff become an active member in the Professional Impact New Jersey Registry prior to approval of your application. (Information has been provided in the application packet) Are you able to meet this requirement? Y N Provide parents with opportunities to volunteer and be engaged One component of this program is an expanded list of participation activities for parents to qualify for the program. This could include volunteering at various levels within the center (greeting parents, assisting with recording e-child Care transactions, assisting with meal and snack preparation, classroom activities etc.) Does your program currently have parent volunteers? Yes or No Describe some creative volunteer opportunities for the parents in your program: Participate in Quality Focused Trainings provided by the CCRR, i.e. Environmental Rating Scale and/or Staff/Child Interaction, Preschool Literacy, and/or Early Learning Standards; and Strengthening Families are required. Staff at your local CCR&R has been trained to administer various professional development trainings to help programs evaluate and improve their program and will offer training. Has your program (within the past two years) participated in an Environmental or any Program Assessment Y / N.? If yes, which one and when; Pease indicate what two trainings from the above you are interested in: E-Child Care New Jersey employs the Electronic Child Care (ECC) system to record time and attendance for children receiving a child care subsidy, and for issuance of direct deposit payment to providers from the state of New Jersey. Your program and parents will be required to use the E-Child Care system and comply with program policies. Are you able to meet this requirement? Y N 3 NJ Department of Human Services New Jersey Summer Enrichment and Literacy Program

4 Strengthening Families- Protective Factors Survey The Strengthening Families Initiative utilizes a survey that is based around the SFI Protective Factors. This is administered at the beginning and end of a program or particular period of time. The results of the survey reveal particular training topic that a center could benefit from based upon the collective responses. Training and technical support is provided. Are you able to meet this requirement? Y N Please provide the following with your application: 1. Copy of your NJ Child Care License 2. Signed Acknowledgement of Requirements and Agreement to Participate contract (included) 3. Staffing plan for a eight to ten weeks summer program. 4. Copy of completed food program application (shell included) 5. Signed Summer Enrichment and Literacy Service Agreement Return all completed applications with supporting documents to: 4 NJ Department of Human Services New Jersey Summer Enrichment and Literacy Program

5 New Jersey Summer Enrichment and Literacy Program Applicant Checklist Program Name EPPIC ID# Program Phone Program Address County CCR&R Checklist Required Document Received Accepted Score Program Creation of a new classroom Two Quality Initiative Commitment Trainings Accreditation Certificate Quality Enhancement Program PINJ Commitment Family Engagement Commitment Utilizing Approved NJ DOE Curriculum Center in good standing with E-Child Care OOL License Staffing Plan Full-time Program USDA/Healthy Menu Commitment TOTAL SCORE OF FIVE FACTORS 0 Program Approved for slots. Quality Scoring (CCR&R) Signature of verifying agent: Title Date Program will not be awarded slots at this time for the following reason(s) 5 NJ Department of Human Services New Jersey Summer Enrichment and Literacy Program