Child Care Center Questionnaire

Here at Options for Working Families, our goal is to provide you with the best opportunity to receive frequent client referrals. We rely upon up-to-date information about your Child Care Program. Please take a few moments to fill in the information below, to ensure that we are providing accurate information to our clients. Please send us a copy of your DCYF license as well as filling out the form. If your program is accredited or any of your employees have a CDA Credential, please enclose a copy of those certificate(s) as well.

*Director's Name

Business Name

* Street Address

*City

* State

* Zip

Mailing address (if different from street address)

Street

City

State

Zip

*Phone number

Fax number

Email address

Website

*DCYF License #

Check all that apply
Provisional license
Probationary license
*DCYF Expiration Date

What schools are near your home?

Language or Languages spoken in your program
English
Spanish
Portuguese
Russian
Hmong
French
Laos
Cambodian
List any other languages spoken

*Hours of Operation

Funding
Head Start Funding
State Pre-K Funding
*What applies to your Child Care Program?
Full year
School year only
Summer only
Before School Care
After School Care
Drop In
Full Time Care
Part Time Care
Both
Rotating Work schedule
Temporary or Emergency Care/Drop In (ie: snow days)
Open Holidays
Rotating
* Have you ever had to expel a child for any reason?
Yes
No
If yes,what was the reason?

*

Check below what applies to your Child Care Program:

Transportation provided by child care program
No transportation
On school bus route
Pick up at school bus stop
Walking distance to school
Near public transportation
Pre-K/Kindergarten/Preschool
Full Day Pre-K
Half Day Pre-K
Half Day Kindergarten
Full Day Pre-school
Half Day Pre-school
*Do you offer FREE Pre-k?
Yes
No
* Is their an additional fee charged for the above services?
Yes
No
Infant/Toddler Rate

Weekly FT

Weekly PT

Hourly FT

Hourly PT

Daily FT

Daily PT

Monthly FT

Preschool Rate

Weekly FT

Monthly PT

Weekly PT

Hourly FT

Hourly PT

Daily FT

Daily PT

Monthly FT

Monthly PT

School Age Rate

Weekly FT

Weekly PT

Hourly FT

Hourly PT

Daily FT

Daily PT

Monthly FT


Additional Fees
Extended Day
Application Fee
Late Payment Fee
Supply Fees
Monthly PT

*Do you accept the DHS Subsidy
Yes
No
Your Provider ID (CCAP Enrollment ID)

Environment
No Pets
Pets
No Pool
Pool on site
*Meals Provided
Breakfast
Morning Snack
Lunch
Afternoon Snack
Dinner
Special Meal Request
USDA Food Program
No meals provided
* Philosophy
Montessori
Religious
Waldorf
Other
Other philosophy if any

Financial Assistance
Are you a sliding scale fee program?
Are you a non-profit program?
Are you an Early Head Start program?
Are you employer supported?
Do you have scholarships available?
Do you have vouchers available?
Are you United Way funded?
Are you part of a parent Co-op program?
If you are employer supported, who is your employer?

* Policies
Child Absence Allowance (no charge when child absence for period of time)
Multi-child Discount
Provider Sick Allowance (Require # of allowable paid sick days for provider)
Provider Vacation Allowance (Require Payment during provider vacation)
Provide daily written family report
Provide verbal reports to family
Written Parent/Provider Contract
Special Skills
Sign Language
Special needs experience
Bi-Lingual
* Safety
CPR (Current within 2 years)
First Aid Training
On-Site Nurse
On-Call Nurse
Health-related degree
Liability Insurance
What kinds of special needs do you have experience with?
Developmental Disabilities
Medical Tech.
Autism Spectrum
Behavioral Health
Physical
Work's with Early Intervention
Work's with Child Outreach
Training
Heads Up Reading Program
CDA
Rhode Island Early Learning Standards
Early Reading First
Other training you would like listed in your profile

Accreditation
Camp
Kindergarten/DOE
NAEYC (Center)
Nursery/DOE
Special Ed
NAA (National After School Association)
Other Accreditation

Additional sites that are also Accredited

Quality Indicators
Bi-lingual Curriculum
Comprehensive Services
DAP/planned written curriculum
Parent/Child Playgroup
Therapeutic Child Care
Written plan for family involvement
Child Care Support Network
* Business Practices
Maintains financial/records
Parent Handbook
Post License Conditions/Age ratios
Written Program Policies
Member Affiliation
CCDA (Child Care Directors Association
NAEYC membership (Centers/Family)
RIEAYC (Rhode Island Education Association of Young Children)
RISAA ( Rhode Island School Age Association)
Other Member Affiliation

Site Coordinator's (School Age Programs) Name

Site Coordinator's (School Age Programs) Education Level
Associates
Bachelor's
Master's
Other
* Director's Name

Director's Experience and Education
1-3 Years Experience
4-9 Years Experience
10-20 Years Experience
Associates
Bachelor's
Masters
CDA
Working on Degree
Other
* Head Teacher's Name

* Head Teachers Education
RI Early Care Ed
BA Early Care Ed or Child Dev
Masters Early Care or Child Dev
Bachelors with course work
Other
* Child Care-Setting
Non-residential
Faith Based
Workplace based
Community based
School based
When was your last DCYF visit?

Infant Age Range

Number of infant vacancies

Preschool Age Range

Number of Preschool Vacancies

School Age Children Age Range

Number of School Age Vacancies

* What days is your child care program open?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Please feel free to add any additional information about your program, that you would like families to know about! (PROGRAM HIGHLIGHTS)

* Is your program currently enrolled in Bright Stars Program?
Yes
No
If yes, what star rating do you currently have?
One Star Rating
Two Star Rating
Three Stars
Four Stars
Five Stars
*

Do you accept pending certificate numbers from families that are receiving child care subsidy?


*Do you have a military discount?
Yes
No




Fields marked with an asteris  (*) are required