GSRP Community Needs Assessment & Application (CNAA)
(New Community Based Agencies ) 2016-17 School Year

Administrative Contact Name

Email Address

Program Name

Program Address

City/Zip Code

Direct Phone Number

License Number

License Effective Dates

Program Days/Hours of Operation

Great Start to Quality SAS and Published Score

School Day Slots (6.5 or more hours daily)

Part Day Slots (GSRP/HS Blend)

Part Day Slots (GSRP)

Yes

Other (please specify)

Yes

Other (please specify)