Virginia Breastfeeding Friendly Early Care Application Survey

Please complete the application to be recognized as a Breastfeeding Friendly Early Care program. Applications are reviewed on a rolling basis. The recognition is good for 3 years and each program will receive an electronic logo designating them as a Breastfeeding Friendly Early Care Program and their information will be displayed on CCAoVA's map of Breastfeeding Friendly Programs. You must attach documentation to support each of the 5 standards listed on the application.

Step 1: Review the application
Step 2: Gather the appropriate documentation
Step 3: Complete the application and upload your supporting documents.
Step 4: You will be notified of your application status with 10 business days.

*Please note that you cannot save this application and return to it later. You can view the application and click through all of the questions as many times as you need to make sure you have all of the information and documentation ready before you actually begin filling out the application.

1.Child Care Program Information

Name of Program

Street Address

City

Zip Code

Phone

Website

Name of director/owner

2.Type of care

3.Total number of children enrolled

Number of children 6 months or younger

Number of children 7 to 16 months

Number of children 17 to 36 months

Number of children being breastfed

Number of teachers caring for children birth to 36 months (include all adults who care directly for these children: lead, assistant, aide, floaters, etc.)

4.Does your program participate in the USDA Child and Adult Care Food Program (CACFP)?

5.Would you be willing to serve as a resource for other programs interested in becoming Breastfeeding Friendly Child Care?

6.I have reviewed and provided information for the Virginia Breastfeeding Friendly Child Care application. I hereby verify the accuracy of this information, and consent to the provision of this application for review; and agree to have the name of this program posted on Child Care Aware of Virginia’s website as a Virginia Breastfeeding Friendly Child Care program.

Name

Title

Electronic Signature

Date

7.Please indicate if this is a new application or a renewal application (if you have previously received this designation).

New application

Renewal application

Current Progress,

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