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RFTS Registration Form 2.0

SECTION 1 : TELL US ABOUT YOU

Oregon Public Health Institute’s Right from the Start (RFTS) program would like to thank you for taking the time to complete this survey.
Right From The Start is a culturally specific program for Black/African/African American childcare and preschool providers in Multnomah, Clackamas and Washington counties. Providers are not required to be state licensed, or license exempt to participate, but 65% or more of children in their care must identify as Black/African/African American or bi/multicultural with at least one parent identifying as Black/African/African American.
Through professional development opportunities, technical assistance, advocacy, and resources; RFTS supports providers as individuals and as business owners as they 1) provide healthy learning environments for children, 2) support holistic health for families, and 3) attain economic stability and growth for their childcare or preschool businesses.
The Right from The Start (RFTS) program would like to learn more about you, the families you serve, and how we can support your needs.
The survey should take no more than 15-20 minutes to complete. The information will be kept confidential.
 
1.What is your first and last name:(Required.)
2.What is the name of your Childcare facility:
3.What is the physical address of your Childcare facility (Apartment/St, City, State, Zip code):(Required.)
4.How many locations do you provide childcare services?(Required.)
5.In which County or Counties is your business location(Required.)
6.Tell us about the number of childcare locations you have in each county(Required.)
7.What is your business phone number: (Required.)
8.What is your personal cell number: (Required.)
9.What is your email address: (Required.)
10.What is the best way to contact you?(Required.)
11.We would like to lift up and honor all the identities that make up our African diaspora. (Please mark all that applies to you:(Required.)
12.What is your preferred language? (Required.)
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