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* 1. QI Navigator Info

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* 2. Program Strategy (See Scenarios Document & WIG Strategies Document)

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* 3. Program Name

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* 4. Program License #

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* 5. Basic Provider Profile

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* 6. Program has been operating for at least 2 years. (Recommended)

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* 7. Director has been director of this program for less than one year (highly recommended to be in position for at least 1 year).

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* 8. If answer above was no-
Did Director served in this position or as a Director in another program for at least 1 year.

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* 9. How many classroom staff vacancies do you have currently? (Criterion to participate: No more than 19% of classroom staff positions are vacant.)

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* 10. We know that program income can fluctuate based on enrollment and timely payments from funding sources. Were there any months in the past 12 months when your program income did not meet expenses? If so, for how many months? (Criterion to participate: No more than 2 months in the past 12 when income did not cover expenses.)

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* 11. In addition to completing the online courses to achieve a Level 2 Rating, you and all your classroom staff will be required to enter their staff qualifications into the new Professional Development Information System, including their formal education, other training, and years of experience. Is the site committed to require 100% of its staff to register in the Professional Development Information System (PDIS)?

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* 12. Are you able to commit to having 75% of your staff complete at least 10 hours of online courses,(required for a Level 2 rating) by the time you apply? What supports are needed to complete the Level 2 professional development requirement?

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* 13. Program has participated in other quality improvement initiatives, but has not recognized a positive impact as a result of participation.

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* 14. Program has participated in other quality improvement initiatives and has recognized a positive impact as a result of participation.

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* 15. Program reports some change in practice or policies to improve program quality in the past 2 years.

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* 16. The change reported in #16 has been sustained for at least 6 months.

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* 17. The program has not closed any classrooms in the past 12 months due to decreased enrollment or decreased funding.

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* 18. The program has opened 1 or more new classrooms due to increased enrollment or increased funding.

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* 19. How many classroom staff have you hired in the past year? In the past 3 months? Did these replace staff who left or have you increased your classroom staff over all?

The program has replaced no more than 30% of its teachers in the past 12 months and no more than 20% in the past 3 months. (If a program has only 1 classroom, this can be as high as 50%). (Required unless unusual circumstances for replacing more than %’s above.)

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* 20. The program has hired new teacher(s) in the past 12 months to improve ratios.

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* 21. If you are eligible and agree to participate in this pilot, a coach will be assigned to assist you and your teachers in completing the self-assessment and developing a Quality Improvement Plan required to achieve a Level 2 rating. Will you be available to meet with a coach from 1 to 2 times a month for up to 4 hours? If not, what would be the maximum time that you could be available?

The director is available to meet with a coach from 1-2 times a month for up to 4 hours OR
The director is available to meet with a coach for up to 2 hours a month. (Required)

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* 22. With support, coverage can be provided for teachers to meet with a coach weekly for 30 minutes OR
With support, coverage can be provided for teachers to meet with a coach twice a month for 30 minutes. (Required)

-Explain that this should be protected time, paid time for classroom staff but when they are not needing to directly supervise the children. You can describe this as a time when a teacher could step out to the hallway/break room/office to meet with the coach so that they can better focus on the conversation. If response is no, ask if any supports would enable them to do this.

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