*1.First & Last Name(Required.)

*2.Mailing Address (Include City, State, and Zip)(Required.)

*3.Phone Number(Required.)

4.Email Address

*5.County you will provide care in? If you are looking to provider care outside of the below areas, you will need to contact your local CCR&R. You can find that information here: https://thrivingwi.org/child-care-resource-referral-network/(Required.)

Adams

Clark

Langlade

Lincoln

Marathon

Marquette

Portage

Taylor

Waushara

Wood

*6.Do you want the packet emailed or mailed to you?(Required.)

Emailed

Mailed

*7.What type ofcare are you interested in providing?(Required.)

Certified Family Child Care (1-3 children, under age 7) https://dcf.wisconsin.gov/cccertification

Licensed Family Child Care (4-8 children, under age 7) https://dcf.wisconsin.gov/cclicensing

Group Child Care (9 or more children outside of home) https://dcf.wisconsin.gov/cclicensing

Unknown at this time

8.Comments/Question