Binghamton City School District



Binghamton City School District

Universal Pre-Kindergarten

Eligible Agency Application

|Agency Name: | |Date: | |

|Address: | |

|Phone: | |Fax: | | | |

|E-mail: | |

|Contact Person: | |

|Hours of operation: | |to | |Days per week: | |

|Months of operation: | |to | |

|Is your program currently licensed or registered? | |

|If so, by whom? | |

Are you a minority or women-owned business?

Please check all applicable program types:

|Propriety: | |Group Family Child Care | |

|Family Child Care | |Center | |

|Nursery | |Non-profit | |

|Head Start | |Community Organization | |

|Public School | |Private School | |

I. Enrollment:

1. Please complete the table below using these instructions:

A Name of classroom/program (only UPK room(s), list separately).

B. Current # of children enrolled in program.

C. Number of current license capacity in proposed classroom.

D. Number of currently enrolled Binghamton City School District children who will be 4 by Dec. 1st.

E. Number of currently enrolled Binghamton City School District children will be 4 by Dec 1st who are currently enrolled in a special education class (subset of D)

F. Age range of children proposed for enrollment.

G. Proposed staff to student ratio.

H. Number of supervisors directly supervising the staff in the classroom.

|A |B |C |D |E |F |G |H |I |

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2. How many of your 4 year olds are (please provide a good approximate)

|Hispanic | |Black |

| | | |

| | | |

| | | |

3. What staff development opportunities do you offer your staff?

III. Facility

1. Do you have access to an indoor gross motor space? If so, describe the space and equipment available.

2. Do you have access to an outdoor space for children’s use? If so, describe the space and equipment available.

3. Please describe your meal or food program.

4. Have you had any violations of health and safety and/or licensure or registration requirements within the past two years? If yes, please describe the violation and its resolution.

IV. Family Engagement

Describe how you engage and support families and use their feedback to improve your program.

V. Fiscal and Administrative Information

1. Do you create an annual balanced budget? __________

Please provide an annual proposed UPK budget. List the portion of the budget that includes parent fees, personnel expenses and materials and supplies. Include any documentation or explanation to support your budget including but not limited to a Parent Fee schedule, salary schedule, and facility expense list.

2. Describe your administrative structure.

V. Instructional Components

Please provide responses to the following on a separate paper:

1. Describe your proposed program model for 4-year-olds in UPK. Address essential elements.

2. Do you foresee any barriers to participating in UPK?

I have included the following documents:

_________ Proposed budget

_________ Copy of current license and/or registration

_________ Hiring Procedures

_________ Copy of teacher’s certificate or plan to obtain one

_________ Enrollment Procedures

_________ Parent Contract

_________ Parent Fee Schedule

_________ Salary Schedule

__________________________________ __________________________

Signature of Director/Owner Date

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