ECMH Classroom Referal - Child Care Resource Center of Baltimore County

Project ACT can only provide consultation services in Baltimore, Harford and Cecil Counties. Click here to locate services in other areas of Maryland.

In what county is your child care program located? Project ACT can only provide this service in the jurisdictions below. *

Baltimore County
Harford County
Cecil County

What is your preferred service delivery method? (Project ACT cannot guarantee a specific delivery model at this time but will work to meet each program's needs.) *

In-person - consultant comes to your program, utilizes PPE, and maintains social distance
Virtual - Zoom, telephone, and email only
Hybrid - in-person visits only when necessary, other visits/meetings done virtually

Classroom needing support: *

How can Project ACT help? *

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Name of Child Care Program *

Address of Child Care Program *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone Number of Center *

Teacher/Family Child Care Provider *

Director (if applicable)

Email of Director/Family Child Care Provider *

License Number *

How many children are enrolled in the program? *

How many children are in the identified classroom? *

How many classrooms are in the program? *

How many staff are in the program? *

How many staff are credentialed? *

Is the program accredited? *

MSDE
NAEYC
No

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Name of individual completing the form: *

First Last

Have you made an Early Childhood Behavioral Consultation referral to Project ACT in the past year? *

Yes
No