Preschool Promise Provider Application 2018-2019 General Program Information Question Title * 1. Program Name: OK Question Title * 2. License Number: OK Question Title * 3. Program Address: Street City Zip Code OK Question Title * 4. Program Email: OK Question Title * 5. Name and Contact Information for Primary Contact: Name Email Address Phone Number OK Question Title * 6. Name and Contact Information for Secondary Contact: Name Email Address Phone Number OK Question Title * 7. Name and Contact Information of Owner (if different than above): Name Email Address Phone Number OK Question Title * 8. Please check the star-rating of your program: Unrated One Two Three Four Five OK Question Title * 9. Please indicate the date you received your star-rating, if applicable: OK Question Title * 10. Please indicate the date your star-rating will expire, if applicable: OK Question Title * 11. Please check all funding sources received by your program: PFCC/Title XX ODE Early Childhood Expansion Slots - if yes, please indicate how many slots you were granted below Head Start How many ECE slots was your program granted? OK Question Title * 12. Do you participate in the Food Program (Child and Adult Care Food Program (CACFP)? Yes No OK Question Title * 13. Were you previously on the Food Program? Yes No OK Question Title * 14. Please check the curriculum you currently implement in your Preschool classrooms: Creative Curriculum High Scope Reggio Montessori Other (please specify) OK NEXT