Description - Early Learning Coalition of Hillsborough County



FORMCHECKBOX OPT OUT - I do not wish to complete this form and understand that my program will not be referred to families by the ELC.(School Readiness and VPK providers contracted with the ELC are required to complete this form.) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Program Name (as it appears on license/registration)SignatureDateName of Person Filling Out Form: FORMTEXT ?????Coalition (ELC)/Agency:Early Learning Coalition of Hillsborough CountyMail to: Hillsborough County Public Schools – CCR&R Dept5701 East Hillsborough Avenue, Suite 2301, Tampa, Florida 33610Phone:(813)744-8941 ext: 232Fax: (813)664-8399Email: shawntaye.beato@sdhc.k12.fl.usDate Form Completed: FORMTEXT ?????Do you wish to have your program referred to families seeking child care listings from the ELC? FORMCHECKBOX YES FORMCHECKBOX NOBusiness Name:(as on License or Exemption) FORMTEXT ?????Doing-Business-As Name: FORMTEXT ?????Owner Name: FORMTEXT ?????Director Name: FORMTEXT ?????Location Address: FORMTEXT ????? City: FORMTEXT ????? County: FORMTEXT ????? Zip Code: FORMTEXT ?????Mailing Address: FORMTEXT ????? City: FORMTEXT ????? County: FORMTEXT ????? Zip Code: FORMTEXT ?????Phone: FORMTEXT ?????Fax: FORMTEXT ?????Email: FORMTEXT ?????Provider Type (check one): FORMCHECKBOX Center FORMCHECKBOX FCCH FORMCHECKBOX Large FCCH FORMCHECKBOX School-age Only FORMCHECKBOX Private School FORMCHECKBOX Public SchoolFamily Child Care Home Only:Do you want your house number and street name to appear on referral lists to families? FORMCHECKBOX Yes FORMCHECKBOX NoLegal Status (check one): FORMCHECKBOX Licensed FORMCHECKBOX Registered FORMCHECKBOX ExemptExemption Type (check one): FORMCHECKBOX Religious Exempt FORMCHECKBOX Camp FORMCHECKBOX Non Public School FORMCHECKBOX Public School FORMCHECKBOX School AgeAffiliation – Not For Profit: FORMCHECKBOX Yes FORMCHECKBOX NoDCF/Local Licensing ID: FORMTEXT ?????Expiration Date: FORMTEXT ?????Master School ID (MSID):(Public and Private Schools only) FORMTEXT ?????Provider Federal ID No: FORMTEXT ?????1. ACCREDITATION - Are you accredited by an accrediting agency? (Check all that apply) A copy of your certificate is required in order for accreditation to be listed.Accrediting AgencyEffective DateEnd Date FORMCHECKBOX ASSOCIATION OF CHRISTIAN SCHOOLS INTERNATIONAL FORMTEXT FORMTEXT FORMCHECKBOX ASSOCIATION OF CHRISTIAN TEACHERS AND SCHOOLS FORMTEXT FORMTEXT FORMCHECKBOX CHOSEN GENERATION LEARNING CENTERS ASSOCIATION FORMTEXT FORMTEXT FORMCHECKBOX ASSOCIATION OF CHRISTIAN TEACHERS AND SCHOOLS (NATIONAL) FORMTEXT FORMTEXT FORMCHECKBOX ASSOCIATION OF INDEPENDENT PRESCHOOLS FORMTEXT FORMTEXT FORMCHECKBOX ACCREDITED PROFESSIONAL PRESCHOOL LEARNING ENVIRONMENT FORMTEXT FORMTEXT FORMCHECKBOX CHURCH AVENUE ACADEMY FORMTEXT FORMTEXT FORMCHECKBOX CHURCH OF GOD ASSOCIATION FORMTEXT FORMTEXT FORMCHECKBOX COUNCIL ON ACCREDITATION FORMTEXT FORMTEXT FORMCHECKBOX CHRISTIAN SCHOOLS OF FLORIDA FORMTEXT FORMTEXT FORMCHECKBOX EARLY CHILDHOOD CHRISTIAN EDUCATION ASSOCIATION FORMTEXT FORMTEXT FORMCHECKBOX FLORIDA ASSOCIATION OF CHRISTIAN COLLEGES AND SCHOOLS FORMTEXT FORMTEXT FORMCHECKBOX FLORIDA CATHOLIC CONFERENCE FORMTEXT FORMTEXT FORMCHECKBOX CENTRAL FLORIDA CHRISTIAN EDUCATION ASSOCIATION FORMTEXT FORMTEXT FORMCHECKBOX FLORIDA COALITION OF CHRISTIAN PRIVATE SCHOOLS ASSOCIATION FORMTEXT FORMTEXT FORMCHECKBOX FLORIDA KINDERGARTEN COUNCIL FORMTEXT FORMTEXT FORMCHECKBOX FLORIDA LEAGUE OF CHRISTIAN SCHOOLS FORMTEXT FORMTEXT FORMCHECKBOX GREEN APPLE ASSOCIATION OF CHRISTIAN SCHOOLS FORMTEXT FORMTEXT FORMCHECKBOX GOLD SEAL QUALITY CARE ACCREDITATION FORMTEXT FORMTEXT FORMCHECKBOX LIGHT OF THE WORLD CHRISTIAN SCHOOL FORMTEXT FORMTEXT FORMCHECKBOX MIRACLE FAITH CENTER FORMTEXT FORMTEXT FORMCHECKBOX MONTESSORI SCHOOL ACCREDITATION COMMISSION FORMTEXT FORMTEXT FORMCHECKBOX NATIONAL ACCREDITATION COMMISSION FOR EARLY CARE AND EDUCATION PROGRAMS FORMTEXT FORMTEXT FORMCHECKBOX NATIONAL ACCREDITATION COUNCIL FOR EARLY CHILDHOOD PROFESSIONAL PERSONNEL AND PROGRAMS FORMTEXT FORMTEXT FORMCHECKBOX NATIONAL ASSOCIATION FOR THE EDUCATION OF YOUNG CHILDREN FORMTEXT FORMTEXT FORMCHECKBOX NEW BEGINNINGS CHRISTIAN CENTER ACCREDITATION FORMTEXT FORMTEXT FORMCHECKBOX NATIONAL ASSOCIATION FOR CHRISTIAN EDUCATION FORMTEXT FORMTEXT FORMCHECKBOX NICENE SCHOOLS INTERNATIONAL FORMTEXT FORMTEXT FORMCHECKBOX NATIONAL COUNCIL FOR PRIVATE SCHOOL ACCREDITATION FORMTEXT FORMTEXT FORMCHECKBOX NARROW DOOR PENTECOSTAL FORMTEXT FORMTEXT FORMCHECKBOX NATIONAL EARLY CHILDHOOD PROGRAMS ACCREDITED FORMTEXT FORMTEXT FORMCHECKBOX NATIONAL ASSOCIATION FOR FAMILY CHILD CARE FORMTEXT FORMTEXT FORMCHECKBOX NATIONAL LUTHERAN SCHOOL ACCREDITATION FORMTEXT FORMTEXT FORMCHECKBOX NATIONAL SCHOOL-AGE CARE ALLIANCE FORMTEXT FORMTEXT FORMCHECKBOX PAPA GOOSE NETWORK OF CHRISTIAN NURSERY’SPAPA GOOSE NETWORK OF CHRISTIAN NURSERY’SPAPA GOOSE NETWORK OF CHRISTIAN NURSERY’S FORMTEXT FORMTEXT FORMCHECKBOX ST. JOSEPH ASSOCIATION OF CHRISTIAN SCHOOLS FORMTEXT FORMTEXT FORMCHECKBOX SONSHINE ASSOCIATION OF CHRISTIAN SCHOOLS FORMTEXT FORMTEXT FORMCHECKBOX SOUTHERN ASSOCIATION OF COLLEGES AND SCHOOLS FORMTEXT FORMTEXT FORMCHECKBOX UNITED METHODIST ASSOCIATION PRESCHOOLS FORMTEXT FORMTEXT OTHER (List Below) FORMTEXT FORMTEXT FORMCHECKBOX FORMTEXT FORMTEXT FORMCHECKBOX FORMTEXT FORMTEXT 2. CURRICULUM - Which of the following curricula does your program use? (Check all that apply) FORMCHECKBOX BABY DOLL CIRCLE TIME – 2012 ed. FORMCHECKBOX INNOVATIONS: THE COMPREHENSIVE INFANT, TODDLER PRESCHOOL -1st ed. FORMCHECKBOX OPENING WORLD OF LEARNING - 2011-2014 FORMCHECKBOX BEYOND CENTERS & CIRCLE TIME -2nd ed. 2007 FORMCHECKBOX INVESTIGATORS CLUB - 2010 FORMCHECKBOX O2B KIDS - 7th ed. 2014 FORMCHECKBOX BEYOND CRIBS & RATTLES - 1st ed. 2005 FORMCHECKBOX INVESTIGATORS CLUB JUST FOR THREES - 2010 FORMCHECKBOX PATHWAYS TO PRESCHOOL - 1st ed. FORMCHECKBOX CORE KNOWLEDGE PRESCHOOL - 2013 FORMCHECKBOX JOURNEY – 2nd ed. 2013 FORMCHECKBOX PINNACLE - 2nd ed. FORMCHECKBOX CREATIVE CURRICULUM FOR FCC - 2nd ed. 2009 FORMCHECKBOX KIDDIE ACADEMY LIFE ESSENTIALS - 2007-2013 FORMCHECKBOX SCHOLASTIC BIG DAY FOR PRE-K English - 1st ed. 2010 FORMCHECKBOX CREATIVE CURRICULUM INFANTS, TODDLERS AND TWOS - 2nd ed. 2011 FORMCHECKBOX KIDS R KIDS - 2013 FORMCHECKBOX SCHOLASTIC BIG DAY FOR PRE-K English/Spanish – 1st ed. 2011 FORMCHECKBOX CREATIVE CURRICULUM FOR PRESCHOOL - 5th ed. 2010 FORMCHECKBOX KNOWLEDGE UNIVERSE EARLY FOUNDATIONS DIS. INFANTS - 2004 FORMCHECKBOX SPLASH INTO PRE-K - 1st ed. 2012 FORMCHECKBOX COMPLETE PROGRAM FOR EARLY LITERACY SUCCESS LEVEL TWO - 1st ed. 2012 FORMCHECKBOX KNOWLEDGE UNIVERSE EARLY FOUNDATIONS TODDLERS - 2014 FORMCHECKBOX STARFALL PRE-K - 1st ed. 2013 FORMCHECKBOX DLM CHILDHOOD EXPRESS - 2011 FORMCHECKBOX KNOWLEDGE UNIVERSE EARLY FOUNDATIONS DISCOVERY PRESCHOOL (18 mos.- 2 yr. olds) - 2004 FORMCHECKBOX STEMscopes EARLY EXPLORER - 1st ed. FORMCHECKBOX EARLY LITERACY & EARNING MODEL PLUS - 2nd ed. 2012 FORMCHECKBOX KNOWLEDGE UNIVERSE EARLY FOUNDATIONS PRESCHOOL (3 yr. olds) - 2013 FORMCHECKBOX TENDER CARE AND EARLY LEARNING - 2nd ed. 2011 FORMCHECKBOX EDUCATION 1st VESS - 1st ed. FORMCHECKBOX KNOWLEDGE UNIVERSE EARLY FOUNDATIONS PREKINDERGARTEN - (4 yr. olds) - 2013 FORMCHECKBOX TOOLS OF THE MIND - 7th ed. 2011 FORMCHECKBOX EMPOWERED CHILD - 5th ed. 2011-2013 FORMCHECKBOX LEARN EVERY DAY & NEMOURS BRIGHT START! SUPERSET - 1st ed. 2012 FORMCHECKBOX WE CAN - 2nd ed. 2014 FORMCHECKBOX FLEX GODDARD PRE-K - 1st ed. FORMCHECKBOX LEARN EVERY DAY FOR INFANT, TODDLERS AND TWOS - 1st ed. 2013 FORMCHECKBOX WEE LEARN INFANTS & TODDLERS - 2000 FORMCHECKBOX FOOTSTEPS FOR FOURS - 2nd ed. FORMCHECKBOX LEARN FROM THE START - 1st ed. 2013 FORMCHECKBOX WEE LEARN TWO-YEAR-OLDS - 1997 FORMCHECKBOX FOUNDATIONS FOR SUCCESS - 2012 FORMCHECKBOX LITERACY EXPRESS - 2014 FORMCHECKBOX WEE LEARN THREE-YEAR-OLDS - 1996 FORMCHECKBOX FROG STREET PRE-K - 2012 FORMCHECKBOX LEAP - 2014 FORMCHECKBOX WEE LEARN FOUR-YEAR-OLDS - 2007 FORMCHECKBOX FROG STREET TODDLER - 2013 FORMCHECKBOX LIFESMART - 5th ed. 2011-2013 FORMCHECKBOX WORLD AT THEIR FINGERTIPS - 2014 FORMCHECKBOX FROG STREET SUMMER - 2014 FORMCHECKBOX LINKS TO EARLY LEARNING - 1st ed. 2014 FORMCHECKBOX FUNSHINE ONLINE - 2014 FORMCHECKBOX LITTLE TREASURES - 2011 FORMCHECKBOX GALILEO PRE-K ONLINE - 2014 FORMCHECKBOX LET’S BEGIN WITH LETTTER PEOPLE - 4th ed. 2009 FORMCHECKBOX GEE WHIZ DIGITAL FOR FAMILY CARE -2013 FORMCHECKBOX MOTHER GOOSE TIME PRESCHOOL - 2014 FORMCHECKBOX GET SET FOR SCHOOL - 1st ed. 2012 FORMCHECKBOX MOTHER GOOSE TIME LITTLE GOOSE - 2014 FORMCHECKBOX HIGHSCOPE PRESCHOOL - 1st ed. 2012 FORMCHECKBOX MONTESSORI3. CAPACITY/ VACANCYTotal Licensed Capacity (Number of children you are licensed to care for) FORMTEXT Actual Capacity (Most number of children you choose to care for) FORMTEXT Current Total Vacancy FORMTEXT 4. ENVIRONMENT - Describe your program’s setting. Check if your staff speaks any of the languages below. (Check all that apply) FORMCHECKBOX Chinese FORMCHECKBOX Smoke Free FORMCHECKBOX Web Cam on siteOTHER (List Below) FORMCHECKBOX Creole FORMCHECKBOX No TV FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX English FORMCHECKBOX PetsOTHER (List Below) FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX French FORMCHECKBOX Pool on Site FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX Filipino FORMCHECKBOX Portuguese FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX Financial assistance FORMCHECKBOX Russian FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX fenced yard FORMCHECKBOX spanish FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX German FORMCHECKBOX separate play area (FCCH) FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX Greek FORMCHECKBOX Sign Language FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX Green Certified FORMCHECKBOX Spa FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX Hebrew FORMCHECKBOX Vietnamese FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX Italian FORMCHECKBOX Video Monitoring FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX Limited tv viewed FORMCHECKBOX Wheelchair Accessible FORMCHECKBOX FORMTEXT ?????5. ADDITIONAL FEES - Please list all additional fees your program charges.DescriptionAmountFrequencyFee Per Child or Family (C/F)Annual $ FORMTEXT FORMTEXT FORMTEXT Application $ FORMTEXT FORMTEXT FORMTEXT diapers$ FORMTEXT FORMTEXT FORMTEXT Insurance $ FORMTEXT FORMTEXT FORMTEXT Late pick-up $ FORMTEXT FORMTEXT FORMTEXT Late payment$ FORMTEXT FORMTEXT FORMTEXT Member Organization $ FORMTEXT FORMTEXT FORMTEXT Meals/Snacks$ FORMTEXT FORMTEXT FORMTEXT Overtime/Early Drop off$ FORMTEXT FORMTEXT FORMTEXT Returned check $ FORMTEXT FORMTEXT FORMTEXT Registration$ FORMTEXT FORMTEXT FORMTEXT school age registration fee$ FORMTEXT FORMTEXT FORMTEXT Supplies/Materials$ FORMTEXT FORMTEXT FORMTEXT Other (List below): FORMTEXT ?????$ FORMTEXT FORMTEXT FORMTEXT FORMTEXT ?????$ FORMTEXT FORMTEXT FORMTEXT Frequency Options: Per Minute; Every 5 minutes; Every 10 minutes; Every 15 minutes; Half Hour; Hourly; Daily; Weekly; Monthly; Yearly; One Time; Per Occurrence 6. MEALS - What meals does your program provide? (Check all that apply) FORMCHECKBOX BREAKFAST FORMCHECKBOX USDA Food Program FORMCHECKBOX Gluten Free FORMCHECKBOX MORNING SNACK FORMCHECKBOX afternoon meal program FORMCHECKBOX Peanut-Free Environment FORMCHECKBOX Lunch FORMCHECKBOX no meals provided FORMCHECKBOX Special Diet Request FORMCHECKBOX Afternoon Snack FORMCHECKBOX Provides Formula FORMCHECKBOX Vegetarian FORMCHECKBOX Dinner FORMCHECKBOX Parent Supplies Formula7. PROGRAM PARTICIPATION – Describe your program/facility. (Check all that apply) FORMCHECKBOX After School FORMCHECKBOX Military FORMCHECKBOX SICK CHILD CARE FORMCHECKBOX Child Care Center FORMCHECKBOX Playgroup FORMCHECKBOX Summer Camp FORMCHECKBOX Early Head Start FORMCHECKBOX PRIVATE SCHOOL FORMCHECKBOX TEEN PARENT FORMCHECKBOX Family Child Care Home FORMCHECKBOX PUBLIC SCHOOL FORMCHECKBOX VPK School Year FORMCHECKBOX Head Start FORMCHECKBOX Quality Rating System FORMCHECKBOX VPK Summer FORMCHECKBOX Large FCCH FORMCHECKBOX School Age Program FORMCHECKBOX Migrant Head Start FORMCHECKBOX School Readiness PrOVIDER8. RATES: In the table below enter the advertised rates (private pay rates) your program charges. Do not include voucher/subsidy rates, sliding scale rates, employee discounts or any other discounted rates. Only complete the rate type for each age group that you offer. (Please attach rate sheet, if applicable).Enter Rate by Age Group.Check frequency for each option below.Infant1 yearold2 yearold3 yearold4 yearold5 yearoldElem School AgeMid School AgeFULL TIME Weekly FORMCHECKBOX Monthly FORMCHECKBOX Annually FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????FULL TIME VPK WRAP Weekly FORMCHECKBOX Monthly FORMCHECKBOX Annually FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????PART TIME Weekly FORMCHECKBOX Monthly FORMCHECKBOX Annually FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????PART TIME VPK WRAP Weekly FORMCHECKBOX Monthly FORMCHECKBOX Annually FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????SCHOOL AGE BEFORE SCHOOL Weekly FORMCHECKBOX Monthly FORMCHECKBOX Annually FORMCHECKBOX FORMTEXT ????? FORMTEXT ?????SCHOOL AGE AFTER SCHOOLWeekly FORMCHECKBOX Monthly FORMCHECKBOX Annually FORMCHECKBOX FORMTEXT ????? FORMTEXT ?????SCHOOL AGE – BOTH BEFORE & AFTER SCHOOLWeekly FORMCHECKBOX Monthly FORMCHECKBOX Annually FORMCHECKBOX FORMTEXT ????? FORMTEXT ?????SUMMER CAMPWeekly FORMCHECKBOX Monthly FORMCHECKBOX Annually FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????9. SCHEDULE - What days of the week does your program operate? (Check all that apply) Sunday FORMCHECKBOX Monday FORMCHECKBOX Tuesday FORMCHECKBOX Wednesday FORMCHECKBOX Thursday FORMCHECKBOX Friday FORMCHECKBOX Saturday FORMCHECKBOX Hours of Operation:Open: FORMTEXT ????? FORMCHECKBOX AM FORMCHECKBOX PMClose: FORMTEXT ????? FORMCHECKBOX AM FORMCHECKBOX PMAges of Children Served:Minimum: FORMTEXT ????? (Months/Years)Maximum: FORMTEXT ????? (Months/Years)10. PROVIDER (ENHANCED) SCHEDULE - Does your program provide the following schedule? (Check all that apply) FORMCHECKBOX 24-Hour Care FORMCHECKBOX Full Time FORMCHECKBOX School Syst Weather Days FORMCHECKBOX After School FORMCHECKBOX Full Year FORMCHECKBOX School Year FORMCHECKBOX Before School FORMCHECKBOX Overnight FORMCHECKBOX sWING SHIFT FORMCHECKBOX Drop In Care FORMCHECKBOX Part Time FORMCHECKBOX Weekend FORMCHECKBOX Emergency/Temporary Care FORMCHECKBOX Respite Care FORMCHECKBOX Evening Care FORMCHECKBOX Summer Only11. ENHANCED SERVICES - What other services does your program offer? (Check all that apply) FORMCHECKBOX Art/Crafts FORMCHECKBOX Music Lessons FORMCHECKBOX environ accommodations FORMCHECKBOX Computers FORMCHECKBOX Kindergarten Class FORMCHECKBOX Training/exp dev delay FORMCHECKBOX Dance FORMCHECKBOX On-site Screenings FORMCHECKBOX Therapeutic Services FORMCHECKBOX Family involvement FORMCHECKBOX Outdoor SportsOTHER (List Below) FORMCHECKBOX Field Trips FORMCHECKBOX Swim Lessons FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX Gymnastics FORMCHECKBOX Training/exp autism FORMCHECKBOX FORMTEXT ????? FORMCHECKBOX Homework/Tutor FORMCHECKBOX Training/exp behav chal FORMCHECKBOX FORMTEXT ?????12. STAFFING – a. Total number of staff that work directly with children in care: FORMTEXT ???______.b.?Enter below the number of staff that works directly with children in care that have any of the following:NumberTraining/ Education TypeNumberTraining/ Education Type FORMTEXT ?????FCCH 30 Hour Training FORMTEXT ?????GED FORMTEXT ?????40 Hr Intro Child Care FORMTEXT ?????High School Education FORMTEXT ?????AA/AS nonchild related FORMTEXT ?????MA Degree Early Childhood FORMTEXT ?????AA/AS early childhood FORMTEXT ?????MA nonchild related FORMTEXT ?????Director Credential Adv FORMTEXT ?????Medical staff onsite FORMTEXT ?????Director Credential lEVEL 1 FORMTEXT ?????Natl Early Childhood Cert FORMTEXT ?????dIRECTOR CREDENTIAL LEVEL 2 FORMTEXT ?????No High School/GED FORMTEXT ?????BA/BS nonchild related FORMTEXT ?????SCHOOL-AGE CREDENTIAL FORMTEXT ?????BA Degree early childhood FORMTEXT ?????SPECIAL NEEDS PRACTICES FORMTEXT ?????BEHAVIOR OBSERVATION FORMTEXT ?????VPK Director Credential FORMTEXT ?????DIRECTOR (NON vpk)Other (list Below) FORMTEXT ?????Doctorate FORMTEXT ????? FORMTEXT ?????Early (eMERGENT) Literacy FORMTEXT ????? FORMTEXT ?????FCCPC/ECPC/CCAC/CDAE FORMTEXT ?????13. SUBSIDIES – List any provider sponsored financial assistance you offer to help families with limited financial means. FORMCHECKBOX EMPLOYER SPONSORED FORMCHECKBOX NEGOTIATED RATE FORMCHECKBOX OTHER (List Below) FORMCHECKBOX Medicaid Provider FORMCHECKBOX Provider Scholarship FORMCHECKBOX FORMCHECKBOX Military Aid FORMCHECKBOX Sliding Scale Fee FORMCHECKBOX FORMCHECKBOX Multi Child Discount FORMCHECKBOX 14. TRANSPORTATION - Do you or does your school provide or are located near transportation? (Check all that apply) FORMCHECKBOX SCHOOL BUS FORMCHECKBOX TRANSPORTATION PROVIDED TO CHILD HOME FORMCHECKBOX TRANSPORTATION PROVIDED FROM CHILD HOME FORMCHECKBOX TRANSPORTATION PROVIDED FROM SCHOOL FORMCHECKBOX NEAR PUBLIC TRANSPORTATION FORMCHECKBOX WITHIN WALKING DISTANCE TO SCHOOLTransportation Provided from the Schools Listed Below to the Child Care SiteTransportation Provided from the Child Care Site to the Schools Listed BelowChild Care Site Within Walking Distance from the Schools Listed Below FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????COMMENTS/QUESTIONS Thank you for your cooperation in gathering this important information. You should contact the Early Learning Coalition of Hillsborough anytime you make changes to your program so that we may provide families with accurate information. We are available to answer any questions you may have by calling the coalition at (813) 515-2340.--- PLEASE ATTACH COPY OF CURRENT LICENSE/REGISTRATION/EXEMPTION AND SUBMIT WITH THIS FORM. ---CCR&R Use Only: FORMCHECKBOX EFS Updated Date: __ FORMTEXT ?????_________ By: __ FORMTEXT ?????___________ ................
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