ECERS R QualityImprovementPlan 3 27 08

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					For office use only:                                            Date Rec’d: __________                      Approved: Y or N
                                                                Reviewers: __________________________________________________



                                                   Child Care Center Quality Improvement Plan
                                                   Early Childhood Environment Rating Scale– Revised (ECERS-R)



Program Name: _________________________________________                             Room: _______ Date: ___________ ECERS-R Score: ___________

Address:            _______________________________________________________________________________________________________
           Street                                                            City                            State    Zip

Name of Program Staff Completing Form: __________________________________________ Title: _________________________________

Phone: ________________                                                             E-mail: ___________________________________________________

Program Director: __________________________________________                         ________________________________________________________
                            (Please Print Name)                                                      (Signature)




Name of Fiscal Agent ____________________________________________________Tax ID # _______________________________________

Address: _____________________________________________________________________________________________________________
           Street                                                            City                             State   Zip

Contact Person: ___________________________________Phone: _______________________ E-mail: ________________________________


Date of conclusion for proposed activities: ___________________


Approved by: _________________________________________________                         Title: ______________________________   Date: ____________
                (Print Name) School Readiness Council / School Readiness Liaison

               _________________________________________________
                (Signature) School Readiness Council / School Readiness Liaison
                                                                              1                                                       Ver. 3-27-08
Complete only for the area(s) for which you are requesting quality improvement funds. (Use additional pages, or insert rows, as needed)
ECERS-              Rater's Description                     Action to be Taken             Resources Needed*             Cost**         Date of
                                                     (list specific actions, timelines and
R Item #               of Deficiencies                             processes)
                                                                                                                                      Completion




Total Amount Requested:

       * Consultants/experts, materials, other items needed to address the need
       ** Specifics such as: # of days, hours, cost per hour, # of materials cost per item




                                                                      2                                                           Ver. 3-27-08
For office use only:                                       Date Rec’d: __________                      Approved: Y or N
                                                           Reviewers: __________________________________________________



                                                  QIP - Child Care Center Quality Improvement Plan
                                                  Early Childhood Environment Rating Scale– Revised
                                                  (ECERS-R)
Results: Please submit this report within one week of completion and mail to Charter Oak State College with all receipts.

Include all areas for which quality funds were requested. (Use additional pages, as needed)
   ECERS                        Description and Documentation of Changes/Actions                              Amount        Date Completed
  Indicator                                                                                                    Spent




Verification of Changes/Actions Completed

Consultant - if applicable (print name): _____________________________       Signature:_______________________________      Date: __________

Program Director (print name): _________________________________             Signature:_______________________________      Date: __________

School Readiness Liaison (print name): __________________________            Signature:_______________________________      Date: __________



                                                                       3                                                       Ver. 3-27-08

				
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