General Program Information 

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* 1. Program Name: 

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* 2. License Number: 

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* 3. Program Address:

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* 4. Program Email:

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* 5. Name and Contact Information for Primary Contact:

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* 6. Name and Contact Information for Secondary Contact:

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* 7. Name and Contact Information of Owner (if different than above): 

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* 8. Please check the star-rating of your program: 

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* 9. Please indicate the date you received your star-rating, if applicable:

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* 10. Please indicate the date your star-rating will expire, if applicable:

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* 11. Please check all funding sources received by your program:

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* 12. Do you participate in the Food Program (Child and Adult Care Food Program (CACFP)?

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* 13. Were you previously on the Food Program?

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* 14. Please check the curriculum you currently implement in your Preschool classrooms:

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