* 1. Today's Date

Date 
/
/

* 2. DCF License Number

* 3. Center Name

* 4. Center Address

* 5. Center Zip Code

* 6. Phone Number

* 7. Name of Owner

* 8. Owner's Email  Address

* 9. Name of Director

* 10. Director's Email Address

* 11. Licensed Capacity 

* 12. Number of Years Operating Preschool

* 13. Hours of Operations

* 17. Do you currently have a:

  Yes No
School Readiness Contract
VPK Contract

* 19. Classroom information

* 20. Students information

* 21. # of School Readiness(SR) Students

* 22. Please indicate the number of staff assigned to each age group:

* 23. Please indicate the number of months/years that staff have been working at your center:

* 24. Please indicate the educational level of teachers (0-12 months):

* 25. Please indicate the educational level of teachers (13-18 months):

* 26. Please indicate the educational level of teachers (19-24 months):

* 27. Please indicate the educational level of teachers (25-35 months):

* 28. Do you have substitutes/floaters employed?

T