FKR Application

Your Name *

First Last

Your Email *

Type of Child Care Program *

Child Care Center
Family Child Care Home

Name of Child Care Program *

Address *

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

License Number

Do you/your staff participate in the Child Care Credential program? *

Yes
No

How many staff persons are in your program? *

How many classrooms are in your program? *

How many children are currently enrolled in your program? *

Do you accept Child Care Scholarship? (e.g. Purchase of Care Voucher, Child Care Subsidy) *

Yes
No

Approximately how many children with Child Care Scholarship do you have currently enrolled? *

Do you participate in the food program (CACFP)? *

Yes
No

Approximately how many children enrolled qualify for the food program (CACFP)? *

Are you willing to commit to 6 months of training and consultation services? *

Yes
No

Participating programs will be required to collect demographic data, including income levels, from parents using a prescribed form. Are you willing to collect this form from all families enrolled? *

Yes
No

Which training and coaching topics would be beneficial for you/your staff? (select all that apply) *

Incorporating social/emotional learning in your classrooms from infants through school age
Providing developmentally appropriate practices throughout all aspects of child development
Workshops for your families regarding child development
Strategies to address challenging behaviors
Learning about trauma-informed care for both the children and staff
Learning about the importance of self-care

What other topics would be beneficial?

What technology do you have available to facilitate virtual coaching visits, if needed? (select all that apply) *

At least 1 Desktop Computer in program
At least 1 Laptop Computer in program
Desktop Computer in each classroom
Laptop Computer in each classroom
At least 1 Tablet (e.g. iPad) in program
Tablets (e.g. iPads) in each classroom
Work-issued Smart Phones

How do you prefer to communicate with a consultant?

What would be your preferred time period for services? *

July 2021-December 2021
January 2022-June 2022
No preference

Foundations for Kindergarten Readiness

Step 1 of 2

Project ACT’s Funders Include