Preschool Promise Provider Application 2019-2020 General Program Information Question Title * 1. Program Name: OK Question Title * 2. Program Address: Street City Zip Code OK Question Title * 3. Program Email: OK Question Title * 4. Name and Contact Information for Primary Contact: Name Email Address Phone Number OK Question Title * 5. Name and Contact Information for Secondary Contact: Name Email Address Phone Number OK Question Title * 6. Name and Contact Information of Owner (if different than above): Name Email Address Phone Number OK Question Title * 7. Please check the star-rating of your program: Unrated One Two Three Four Five OK Question Title * 8. Please indicate the effective date of your star-rating, if applicable: OK Question Title * 9. Please indicate the expiration date of your star rating, if applicable: OK Question Title * 10. 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 If you have ECE Slots - how many do you have and what do you charge a family to stay full-time? OK Question Title * 11. Do you participate in the Food Program (Child and Adult Care Food Program (CACFP)? Yes No OK Question Title * 12. Were you previously on the Food Program? Yes No OK Question Title * 13. Please check the curriculum you currently implement in your Preschool classrooms: Creative Curriculum High Scope Reggio Montessori Other (please specify) OK Question Title * 14. How many additional 4 year-old Preschoolers could you accept into your program today? OK NEXT