School Readiness Provider Contract Monitoring Question Title * 1. What county are you located? Question Title * 2. What is the name of your contracted School Readiness program? Question Title * 3. What is your FEIN? Question Title * 4. Answer the following: Owner First Name: Owner Last Name: Director First Name: Director Last Name: Question Title * 5. What date was the School Readiness contract signed? (use MM/DD/YYYY format) Question Title * 6. Do you have evidence of use of your identifed curriculum? Yes No Describe your evidence below. Question Title * 7. Do you have evidence of use of your identifed character curriculum? Yes No Describe your evidence below. Question Title * 8. When was your program evaluation completed? (use MM/DD/YYYY format) Question Title * 9. What date was your most recent child screening results (ASQ) submitted to the Coalition? (use MM/DD/YYYY format) Question Title * 10. Do you have evidence that child assessments using Teaching Strategies Gold (TSG) have been completed by the required deadline? Yes No Describe your evidence below. Question Title * 11. Do you have evidence of submitted requests to the warm line? Yes No Describe your evidence below. Question Title * 12. Do you have evidence of family involvement activities at your program? Yes No Describe your evidence below. Question Title * 13. Do you have evidence that the professional development requirements for your center have been or are in the process of being completed? Yes No Describe your evidence below. Question Title * 14. Do you have evidence of DCF or Coalition Health & Safety monitoring that has been completed at your program? Yes No Describe your evidence below. Question Title * 15. Do you have evidence that you have met the requirements for notification of changes to the Coalition? (answer as applicable) Yes No Describe your evidence below. Question Title * 16. What is your working land line phone number? (use xxx-xxx-xxxx format) Question Title * 17. What is your current email address used for Coalition correspondence? Question Title * 18. Do you have evidence that shows you maintain confidential records correctly? Yes No Describe your evidence below. Question Title * 19. Do you have evidence that shows you comply with current child abuse reporting requirements? Yes No Describe your evidence below. Question Title * 20. Do you have evidence that shows you comply with reporting requirements for unusual incidents? Yes No Describe your evidence below. Question Title * 21. Do you have evidence that shows you comply with Rilya Wison reporting requirements? Yes No Describe your evidence below. Question Title * 22. Do you have evidence that you enroll School Readiness children only when you have Coalition authorization? Yes No Describe your evidence below. Question Title * 23. Do you have evidence that you submit sign-in and sign-out sheets with monthly attendance? Yes No Describe your evidence below. Question Title * 24. Do you have evidence that you meet the requirements for notification of child absences? Yes No Describe your evidence below. Question Title * 25. Do you require all staff to complete confidentiality agreements? Yes No Describe your evidence below. Question Title * 26. Are all staff aware of your written process for protecting confidential information? Yes No Describe your evidence below. Question Title * 27. What date was your most recent provider rate statement submitted to the Coalition? (use MM/DD/YYYY format) Question Title * 28. Do you have evidence that you meet the requirements for payment rate discrepancies? Yes No Describe your evidence below. Question Title * 29. What date was your most recent direct deposit form submitted to the Coalition? (use MM/DD/YYYY format) Question Title * 30. Do you have evidence that you submitted a COOP/Emergency preparedness plan to the Coalition? Yes No Describe your evidence below. Question Title * 31. Do you have evidence that your insurance coverage and requirements are current and sufficient? Yes No Describe your evidence below. Question Title * 32. Do you have evidence that payment validation and feedback has been provided to you from the coalition? Yes No Describe your evidence below. Done