Exit this survey Update your Child Care Center 1. Question Title * 1. Please list your current contact information below. Director Name: Program Name: Address: City/Town: State: Zip: Email: Phone number: Question Title * 2. Licensing information (You can refer to you EEC license to find this information) If your program is excempt simply type excempt in the program number field. Program Number License Number Infant Capacity Toddler Capacity Preschool Capacity Total Capacity License Expiration Date Question Title * 3. Please complete the information below regarding ages of children and current vacancies. Age range of children accepted (ex. 3 - months - 12 years) Number of infant vacancies (0-15 months) Number of toddler vacancies (15-33 months) Number of preschool vacancies (33 months-schoolage) Total number of vacancies Question Title * 4. What are your days and hours of operation? Monday Tuesday Wednesday Thursday Friday Other Question Title * 5. What do you charge families? Please enter your rate information by age group Infant full time weekly rate Infant part-time weekly rate Toddler full time weekly rate Toddler part-time weekly rate Preschool full time weekly rate Preschool part-time weekly rate Nursery two-day weekly rate Nursery three-day weekly rate Question Title * 6. Please select all that apply to you childcare program environment. NAEYC Accredited Adult pool Air Conditioned Wheelchair Accessible Pets (list what type below) No Pets Smoke free environment Fenced yard Peanut free Uses Public playground Transportation provided What type of pet? Question Title * 7. What type(s) of financial assistance do you accept? (Please check all that apply) State subsidy (Voucher) United Way funding Private Scholarships slidling Fee Scale Contracted Slots DSS Supportive Slots Sibling Discount Teen Parent Slot Other Please specify Question Title * 8. Do you have experience and / or training in any of the following special needs? Please check all that apply. ADD/ADHD Asthma/Allergies At Risk Children Autism Behavioral Developmental Emoptional/Social Feeding Tube Hearing Impairment Learning Disabilities Medical Conditions Monitors Physical Disabilities Special Diet Speech/Language Visual Impairment Other (please specify) Question Title * 9. Please describe your program and/or what type of activities you offer the children? (This is shown on the profile of your program given to parents.) Question Title * 10. What QRIS level is your program at? Level 1 Level 2 Level 3 Level 4 Done
