SurveyMonkey Powered Online Survey

Provider Update Form

Thank you for taking time to provide us with information regarding your child care business. This information will assist us in providing families in need of child care with accurate referrals to your child care and/or in understanding the needs of our communities related to child care. Please note: Referrals will only be made if you have indicated that you would like to receive them. Only those meeting referral requirements are eligible for referrals. For more information on referrals please call our office. All information provided to our office is confidential and will only be shared with your consent.

Contact Information(Required.)

Contact for referrals and/or updates (first and last name)

Name listed on license/registration

License/Registration/Exempt number (If you have multiple sites and the information is the same, please list them all. Or fill out this survey for each site.)

Business name

Primary phone

Secondary phone

Mailing Address (if different from site address)

Referrals(Required.)

Yes

I would like CASY to refer families to my program.

Yes

I would like families to be able to contact me when they complete online referral searches.

Yes

Does child care staff speak more than one language fluently? If yes, please list below.

Environmental features of your child care program (select all that apply)

Does your child care program provide care ONLY for any of the following groups?

Does your program accept these funding sources?

Head Start Funding

Seasonal/Migrant Head Start

Early Head Start

Transportation

On or near public transportation route

To/From school (on school bus route)

To/From child's home

Walking distance to/from school

School(s) that participate with bus transportation to your program, or you provide transportation to/from:

Hours of Care
(If your hours need changed, you must email Administrative Support, which can be found on FSSA's website.)

Open

Same hours every Monday - Friday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

If your program completely closes in-between these times, please share this information below.

Accepting

Full-time only

Part-time only

Both

Duration

Full year

School year only

Summer only

Vacancies per Age Group(Required.)

Infants: 0-12 months

Toddler: 13-23 months

Toddlers: 24-35 months

Preschoolers: 3 years

Pre-K: 4-5 years

School Age: Before/After School only

School Age: Summer Care

Please enter your current rate information below. Note: Rate information is never provided to the families looking for care. We collect rate information to provide to the FSSA Office of Early Childhood & Out-of-School Learning during Market Rate surveys. It is important to have up to date records of rates for programs in order to base an average cost of care for the county you serve.

Weekly Rates(Required.)

Infants: 0-12 months

Toddler: 13-23 months

Toddlers: 24-35 months

Preschoolers: 3 years

Pre-K: 4-5 years

School Age: Before/After School only

School Age: Summer Care

Age Range

years

months

From:

To:

Desired age range (For example, I am licensed for infants, but chose not to take children younger than 1 year.)

Definitions
Licensed/Registered capacity - the capacity number on your license or registration.
Desired capacity - the number of children you are able to care for at this time while taking staffing, available space, or other factors into account. This number may be lower than licensed capacity.
Vacancies - total number of spots available at this time.

Capacity

Licensed/Registered Capacity

Desired Capacity

Vacancies

CCDF Details

CCDF Eligible, but does not accept vouchers.

I don't know what CCDF is. Please send me information on it.

Additional information, comments, questions?
Anything else you would like us to know about your program?

Are there resources you would like sent to you?

Thank you for your time!
Kati Colvin
Program Resource Navigator
kcolvin@casyonline.org
(812) 231-8902