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Childcare Northeast Tennessee Profile
Childcare Northeast Tennessee Program Profile Form
Please complete the form to register your program with Childcare Northeast Tennessee.
*
1.
Name of Childcare Program
(Required.)
*
2.
Address of Program
(Required.)
Street Address
City
State
ZIP
*
3.
Primary Contact
(Required.)
Email Address
Phone Number
*
4.
Web Address
(Required.)
5.
Provider Type
Center
Head Start
Family Home
Group Home
Other (please specify)
*
6.
Ages Served
(Required.)
Infants
Toddlers
Three Year Olds
Four Year Olds
Five Year Olds
School Age
Other (please specify)
None of the above
*
7.
Hours of Operation
(Required.)
*
8.
Number of Children on Program License
(Required.)
*
9.
Enrollment Contact
(Required.)
Name
Email Address
Phone Number
*
10.
Do you have income-based fees
(Required.)
Sliding Scale/DHS Certificate
No
*
11.
Do you serve meals
(Required.)
Yes
No
Only Snacks Provided
*
12.
Is your program ADA compliant
(Required.)
Yes
No
*
13.
Does your program offer transportation
(Required.)
Yes
No
*
14.
License
(Required.)
DHS
DOE
Other (please specify)
15.
DHS Star Rating
1 star
2 stars
3 stars
*
16.
Can we use your program name in publicity for Childcare Northeast Tennessee
(Required.)
Yes
No
17.
Please provide a short description of your for your program profile
*
18.
Please upload a photo of your entrance, sign, or playground for your program profile
(Required.)
Choose File
No file chosen
19.
Would you like to learn more about the substitute teacher service?
