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* 1. Name:

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* 2. Email Address:

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* 3. Title/role:

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* 4. Child Care Program Name:

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* 5. Provider number/Location number:

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* 6. Location (Address, City, County):

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* 7. Group or Family Provider?:

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* 8. Number of children enrolled on average for a year*:
*We understand this number fluctuates, please just report the number of children typically enrolled at your program during your highest enrollment point of the year.

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* 9. Do you serve Wisconsin Shares recipient families?

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* 10. Have you completed any business practices training in the past? If so, who provided it, when did you complete it? List all. (Examples: WECA/WEESSN, YoungStar, Tom Copeland, other national training)

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* 11. Do you have an existing business plan? If so, when was it last updated? How did/do you use it?

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* 12. What are you hoping to learn or accomplish from participating in this cohort?

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* 13. I certify that I will attend all sessions and complete the business plan 

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