Child Care Connection Application Form - PDF

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Child Care Connection Application Form - PDF Powered By Docstoc
					                                                               Quality Counts Child Care Grant Program
                                                                     Funded by the Illinois Department of Human Services, Bureau of Child Care & Development

                                                                                                        APPLICATION FY2008
        West Central Child Care Connection                                       Phone: (217) 222-2550                                   Please type or print using black or blue ink.
                                                                                                                                         The original application and budget forms
        510 Maine St., Rm. 610                                                   Email: robin@wcccc.com                                                 must be used.
        Quincy, IL 62301                                                         Website: www.wcccc.com
                    Please refer to the Quality Counts Child Care Grant Guidelines & Requirements for assistance in completing this application.
 CONTACT INFORMATION:
Program/FCC Name:                                                                                      Contact Person Name:
(Licensed - name as it appears on license)

Mailing Address:
City:                                                                       County:                                                         State:          ZIP Code:
Program Location:
City:                                                                       County:                                                         State:          ZIP Code:
Phone: (            )                                                     H          W           C Alternate Phone: (             )                                           H        W   C
Fax: (         )                                                                                     E-mail:
Program is:             For-Profit             Not-for-Profit                                          Social Security or Federal ID Number:

 PROPOSAL INFORMATION                                                                         (See Guidelines & Requirements Section 2 #8 & #9)

Priorities You May Be Addressing in Your Proposal: (Check any and all that apply)
    Increasing capacity for infants/toddlers.                                Improving the quality of care for infants/toddlers.
    Increasing capacity for school-aged children                             Improving the quality of care for school-aged children
     (Full-year or school year only).                                                                          (Full-year or school year only).
      Creating the ability to accommodate children and families with                                           Maintaining the ability to accommodate children and families with
      special needs*.                                                                                          special needs*.

                                     * A child with special needs is a child who has been diagnosed by a professional and receives special services from the public school,
                                                                  a community agency or regular care by a physician for a medical condition.

                           I am applying for: ____ Category 1 Funding ____ Category 2 Funding                                   (See Guidelines & Requirements Section 1 #1 – #6)
                                        If applying for Category 2 Funding, complete & attach the Category 2 Funding Sheet Attachment A.
                   License-Exempt Family Child Care Program must complete either Attachment A or the License-Exempt Family Child Care Checklist Attachment B.
Amount & Purpose of Funds Requested:                                                         Did you or a person from your agency attend the Bidders’ Conference?
(See Guidelines & Requirements Section 6 #22 - #26 and Section 3 #13 & #14)                  (See Guidelines & Requirements Section 2 #10 & #11)
♦Please transfer dollar amount totals from the ITEMIZED BUDGET FORM                              Yes        No      Date Attended: _____/_____/_____
AFTER completing your budget.♦
                                                                                             Name of person who attended: _______________________________
Amount of funds which will affect:
       Equipment/Materials for Children                                                     Did you receive a Quality Counts Grant last year?                        Yes         No
                                                                                             (See Guidelines & Requirements Section 2 #10 and Section 6 #21)
                        Infant           $___________
                        Toddlers         $___________                                        Are there any other funds to support your request?
                        2 Year Olds      $___________
                                                                                                 Yes        No       If yes, amount of funds? $________________
                        Preschool        $___________
                        School Age       $___________                                        Are the items you are requesting required by:
        All Ages (3 or more age groups)  $___________                                        (See Guidelines & Requirements Section 4 #19)
                        Special Needs    $___________                                        IDCFS Licensing?                 Yes        No
                                                                                                  If yes, please attach a:
       Facility Improvement
                                                                                                       Copy of corrective action plan or IDCFS letter, and/or
                  Infant/Toddlers Only                $___________
                        All Other Ages                $___________                                     List of licensing standards you are addressing only if transitioning from
                                                                                                       License-Exempt to Licensed and have written timeline/plan in place.
       Professional Resources                        $___________
                                                                                             Fire Marshall?             Yes         No
       Family Resources                              $___________                              If yes, please attach a copy of the document from the Fire Marshall.

                                                                                             Health Department?                 Yes        No
                             Total Amount:                                                       If yes, please attach a copy of the document from the Health Department.
This amount must equal the breakdown above and the total on your
Itemized Budget Form.




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   PROGRAM INFORMATION

 ACCREDITATION (See Guidelines & Requirements Section 1 #5)
 ♦You are required to attach proof of accreditation from issuing body.♦
 Is your program accredited?     Yes      No
  If yes and you are applying for Category 2 Funding you must complete and attach Attachment A.
     License-Exempt Program                 Licensed Program – License ID # ________________________________________
 Program Type:           Family Child Care Home                  Group Family Child Care                  Child Care Center            Head Start          ISBE
 Funding Source(s): (Check all that apply)
    Tuition / Fees                                              ISBE Early Childhood Block Grant                                    IDCFS Voucher/Certificate
    Corporate Sponsored                                         CDHS Site Contract (Chicago Dept. of Human Services)                Hospital Sponsored
    Government Sponsored                                        Community College Sponsored                                         Faith-Based Sponsored
    IDHS Voucher/Certificate                                    IDHS Site Contract
 Is your program listed on the WC/CCC provider database?                      Yes          No   (See Guidelines & Requirements Section 3 #12)
 (If no, you must call us prior to submitting this application in order to be eligible for funding.)
 Number of years you have been providing legal child care in your current (physical) location:
   Less than 1 year          1-2 years            3-5 years            6-9 years            10-14 years                                    15 or more years
 You enroll children:                   Full-time               Part-time                  Both
 Hours:       Full Day (8 or more consecutive hours providing care)                    Open: _____ AM to _____ PM
 Days you provide child care:    Monday through Friday                    OR Only open the following days:
        Sunday            Monday         Tuesday                          Wednesday        Thursday                          Friday             Saturday
 Your overall program is:            Full-Year (at least 49 weeks per year)         School-Year
 Do you provide school-age care?              Yes         No (If yes, check the one that best applies to your program)
     Before and/or After School (49 weeks including school holidays, closing and breaks)                Before and/or After School - School Year Only (180 days/9 months)
     Summer (3 months minimum of 8 hours per day)                                                       School Holidays
     Closing and Breaks Only
 If you are a family child care provider, do you own your home?                     Yes            No
 If you are a child care center, do you own or rent the facility?                   Own            Rent

  CAPACITY/ENROLLMENT                                                                Information by Age Group
Capacity Definition: For licensed centers and homes, this is the capacity listed on your IDCFS license. For license-exempt centers and homes, this is
the number of children that could be cared for by your program at any one time.
Enrollment Note: Number of Children Enrolled can exceed the number of children at any one time due to part-time children and/or shift care.
Family Child Care1: For family child care, please include your own children under age 13, in total enrollment.
Changes in Capacity2: Any changes in capacity MUST be supported in your grant narrative and must fall into one of the following categories:
      ♦Licensed facility increasing license capacity (attach DCFS documentation regarding the plan)
      ♦License exempt center or home becoming licensed
      ♦ New age categories as long as the license allows

                                                                                 Family                                                Capacity Increases         Number of Children
                                                                                                               Number
                                                     Center               Child Care Capacity                                          (Number of Spaces             with Special
             Age Category                                                                               of Children Currently
                                                    Capacity             (Place total as listed on                                    Grant Is Expanding)2         Needs Currently
                                                                                                              Enrolled1
                                                                           your DCFS license)                                            (If Applicable)            Being Served

Infants (6 weeks to 14 months)
Toddlers (15 months to 23 months)
2 Year Olds (24 Months to 35 months)
Preschool (36 months to 59 months)
School-age (60 months to 12 years)

Total

      Do you provide care for other types of schedules? Please provide detail.
         Evening (6 PM – 10 PM)         Total Capacity: __________ Total Enrollment: __________
         Night (10 PM – 6 AM)           Total Capacity: __________ Total Enrollment: __________
         Weekend                        Total Capacity: __________ Total Enrollment: __________



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  CHILD CARE FINANCIAL ASSISTANCE


Do you currently care for children whose families receive IDHS child care financial assistance (CCAP/subsidy)?
    Yes             No

If yes, please complete the following formula to determine the percentage of children in your program receiving IDHS child care financial assistance.


                                                                                   To calculate:
                             Total Number of children with IDHS Child Care Financial Assistance DIVIDED by Current Total Enrollment*
                                         MULTIPLIED by 100 EQUALS Percentage of Children Receiving IDHS Assistance.
                                       (FCC providers: please include your own children, under age 13 in total enrollment)

                                                      ______________        ÷ _____________ x 100 = _________________%
                                                       # of IDHS Children     Total Enrollment        Percentage of IDHS Children

           *Enrollment on the date this application is completed.


   GRANT NARRATIVE REQUIREMENTS
(See Guidelines & Requirements Section 4 #17 and Section 5 #20)
Answer the following questions and attach them to your application/budget proposal.
(Limit narrative to 5 DOUBLE SPACED PAGES. The font size should be no smaller than 10 point.)
If you are applying for Category 2 Funding you should reference your program self-assessment results or relate how additional funding will assist
your program in maintaining or receiving accreditation or comply with Head Start standards in numbers 2, 3 and/or 4 below.

      1)      In 50 words or less, provide a brief overview of the purpose of your grant proposal.
      2)      Describe the need for your request.
      3)      Describe how your request will:
              a) Meet one or more of the four quality indicators (see Guidelines and Requirements Section 2 #7).
              b) Create and/or improve high quality child care.
              c) Enhance children’s growth and development and/or support families and/or practitioners in your program.

      4)      Will your proposal meet one or more of the following priorities? If yes, please describe how it will:
              a) Increase capacity and/or improve the quality of care for infants and toddlers. If increasing capacity or adding new age categories, describe
                   your plan and include supportive DCFS documentation.
              b) Increase capacity and/or improve the quality of care for school-age children. If increasing capacity or adding new age categories, describe
                   your plan and include DCFS documentation.
              c) Create and/or maintain the ability to accommodate children and families identified with special needs.

      5) List and describe the item(s) in your budget which is/are of highest priority. (List high priority budget items first)
      6) Will you be able to complete your project if awarded partial funding? If yes, please explain.
      7) Include additional information about you or your program that may be helpful in reviewing your proposal (optional).


  AUTHORIZATION

I certify that the above information is true and accurate, that I have not been indicated of child abuse and neglect and that my name or employees are
not listed on the child abuse tracking system. Further, I grant permission for a representative of the Illinois Department of Children and Family
Services or their agent to release information about a pending or current Day Care Home, Day Care Group Home or Day Care Center license.

_____________________________________________________                                        ________________________________
Authorized Signature                                                                        Date




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APPLICATION CHECKLIST

      I completed all areas of the current application. If a question was not applicable I inserted N/A.
      I used the current application and budget form as required.
      I checked the numbers on my budget form for accuracy.
      If I am requesting monies for contracted work, I attached two itemized bids or estimates. (Use preferred bid in budgets.)
      I made a copy of the completed application, budget and grant narrative for my own records. I understand originals will
      not be returned.
      I enclosed the original copy of all materials in order: (1) application; (2) budget; (3) grant narrative; and (4) supporting documents.
      I enclosed 3 additional copies of all materials in order: (1) application; (2) budget; (3) grant narrative; and (4)
      supporting documents.
      If applicable, I attached the following documentation to each of the 4 sets:
           Fire Marshall document and/or                 List of licensing standards specifically addressed (license status change only) and/or
           Health Department document and/or             Proof of accreditation from issuing body.
           IDCFS corrective action plan and/or
      I signed and dated my application.
   FOR THOSE WHO ARE APPLYING FOR CATEGORY 2 FUNDING ONLY
   If your program is currently Accredited:
       I submitted a copy of certification of accreditation from organization
       I completed the Category 2 Funding Sheet Attachment A Section 1 only
       I attached the Category 2 Funding Sheet Attachment A along with my application
   If your program is currently enrolled in Accreditation Self-Study
       I submitted a copy required documentation from organization
       I submitted a copy of the receipt of payment from the organization
       I completed the Category 2 Funding Attachment A Section 2 only
       I attached the Category 2 Funding Sheet Attachment A along with my application
   If you completed a Self-Assessment (s) on your program.
       I completed an appropriate Self-Assessment Tool
       I entered my assessment scores in the appropriate area of the Category 2 Funding Attachment A in Section 3 Only.
       I attached the Category 2 Funding Sheet Attachment A along with my application
   If your program is a Head Start program
       I completed the Category 2 Funding Sheet Attachment A Section 4 only
       I attached the Category 2 Funding Sheet Attachment A along with my application.
   For License-Exempt Family Child Care Only
      I completed the License-Exempt Family Child Care Checklist Attachment B.
      I attached the License-Exempt Family Child Care Checklist along with my application.


Return all required documents by November 9, 2007 to:
                                                                                       West Central Child Care Connection
                                                                                       ATTN: Robin Ayers
                                                                                       510 Maine, Rm. 610
                                                                                       Quincy, IL 62301




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                                 QUALITY COUNTS CHILD CARE GRANT PROGRAM
                                       GUIDELINES & REQUIREMENTS
                                                2007-2008
This list of commonly asked questions will assist you with completing your grant proposal and answer many of your questions
regarding the grant program’s policies. This page lists all the questions that are answered in the following pages. Please read all
materials carefully. If you have any further questions please contact: Robin Ayers
                                                                           robin@wcccc.com
                                                                           (217)222-2550 or 800-782-7318
Section 1:   Quality Counts Grant Funding Information for 2007-2008
        1.    How much grant money can a program apply for?
        2.    How can a program become eligible to receive Category 2 funding?
        3.    Where do I get information on an accreditation process and what is the cost?
        4.    At what point in the accreditation process is a program considered “enrolled in accreditation self-study”?
        5.    What documentation do I need to provide as proof of accreditation or accreditation self–study?
        6.    Which program assessment tools will be accepted?
Section 2: The Quality Counts Grant
        7. How do you define Quality Care and how do I need to address it in my program’s grant application?
        8. Who will be reading the grant application and how will it be scored?
        9. Which grant proposals receive higher consideration?
        10. Which programs receive higher consideration?
        11. Do I have to attend the Quality Counts Bidders’ Conference in order to apply?
Section 3: Making the Decision to Apply for a Quality Counts Grant
        12. Who can apply for a Quality Counts Grant?
        13. What can a program request in a grant?
        14. What can’t a program apply for?
        15. Can I submit more than one application? Can I submit one application if my business/agency has more than one
            site?
Section 4: The Quality Counts Application
        16. What is a complete Quality Counts Application?
        17. What is the page limit for the Narrative section and what should it include?
        18. How much detail should be provided on the budget?
        19. When should an IDCFS corrective action plan, Fire Marshall documentation, Health Department documentation
            and/or IDCFS licensing standards be attached?
Section 5: Successful Grant Writing
         20. I’ve never written a grant before, what are some tips?

Section 6: Frequently Asked Questions
        21. If the program received a grant last year can we apply again?
        22. If my program’s grant is approved will the full amount of money requested be received?
        23. How many grants will be awarded?
        24. If awarded funding, how does my program receive the funds?
        25. Is this a grant or loan? Do I have to pay it back?
        26. When are applications due?
        27. Can I mail the proposal or bring it to the office?
        28. When will I know if my program has been awarded funding?
Section 7: Important Key Points to Remember




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                                      QUALITY COUNTS CHILD CARE GRANT PROGRAM
                                             GUIDELINES & REQUIREMENTS
                                                      2007-2008

The Quality Counts Grants are intended to improve the quality and/or increase the capacity of child care programs. The Illinois
Department of Human Services (IDHS) provides funding for the grant.

SECTION 1: QUALITY COUNTS GRANT FUNDING INFORMATION FOR 2007 - 2008
Please note: there are significant changes to the Quality Counts Grant Program for the 2007/2008-grant year. It is strongly recommended
that you read the Guidelines & Requirements and review the Application in its entirety before beginning the grant application process. Your
local CCR&R will provide technical assistance, Bidder’s Conferences and related training to guide you through these changes.
    1. How much grant money can a program apply for?
                                                   Maximum Category 1 Funds                           Maximum Category 2 Funds
                                               ♦All programs are eligible to apply for            ♦Program is accredited, enrolled in
              Provider Type                                                                  accreditation self-study and/or has completed a
                                                       Category 1 Funding♦
                                                                                                       program self-assessment♦
 License Exempt FCC Homes                                      $750.00                                           $1500.00
 Licensed FCC Homes                                           $1000.00                                           $2000.00
 Licensed Group Homes                                         $1300.00                                           $2600.00
 Licensed & License-Exempt
 Centers: (Capacity)

                          50or less                       $2700.00                                         $5400.00
                               51 – 100                   $5400.00                                        $10,800.00
                                   101 +                  $8000.00                                        $16,000.00
                   ♦ Each application must request a minimum of $100. Grant applications may be fully or partially funded.
                            Do not request more than the maximum amount for your type of program. ♦

Helpful Definitions:
Accredited/Accreditation: The process through which child care programs voluntarily meet specific standards to receive endorsement from a
national agency.

Accreditation Self-Study: Applies to programs that are in the process of becoming accreditated. See question #4 for specific information.

Program Self-Assessment: An evaluation tool that providers use to determine a program’s strengths and areas in need of improvement.
Assessments are based upon observation of the overall program and its environment.

License-Exempt Family Child Care Checklist: A tool designed for License-Exempt Family Child Care providers to evaluate a program’s
strengths and areas in need of improvement. Assessments are based upon observation of the overall program and its environment.
    2. How can a program become eligible to receive Category 2 funding?
         Only programs that are currently accredited or enrolled in accreditation self-study, Head Start program, or complete an approved
         program self-assessment/License-Exempt Family Child Care Checklist will be able to apply for Category 2 funding. It is optional
         for programs that are accredited or enrolled in accreditation self-study to complete a self-assessment. Programs that are not
         accredited, or in accreditation self-study, and do not complete a self-assessment will be able to apply for a grant, but only for Category
         1 funding.

    3. Where do I get information on an accreditation process and what is the cost?
         Cost may vary for each accreditation. Programs interested in obtaining accreditation may apply for Professional
         Development/Program Improvement funding assistance through their local CCR&R agency. The following agencies and accreditation
         procesess are recognized by IDHS for this grant program. For technical assistance please contact your local CCR&R.




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    Center - Based Programs:
                  NACCP: National Association of Child Care Programs
                  NAEYC: National Association for the Education of Young Children
                  NECPA: National Early Child Care Program Accreditation
    School – Age Programs:
                  NAA: National AfterSchool Association
    Family Child Care Programs:
                  NAFCC: National Association for Family Child Care

4. At what point in the accreditation process is a program considered “enrolled in accreditation self-study”?
    For programs in the process of becoming accredited they must be in a following stage of accreditation.
    NAEYC: Submitted the Step 3: Candidacy Materials Form
    NECPA: Submitted the Request for Verification Visit Form.
    NAC: Submitted the Request for Validation Visit Form.
    NAFCC: Submitted the Request for Observation Visit Form.
    NAA: Submitted the Request for Endorsement Visit.

5. What documentation do I need to provide as proof of accreditation or accreditation self-study?
    If your program is currently accredited you must submit a copy of your certification of accreditation from the accrediting organization. If
    you are in the process of accreditation, you must submit a copy of the following forms. You must also submit a receipt of payment
    from the agency. If you no longer have these documents you will need to request the information from the agency directly.
    NAEYC: Submit: Step 3 Application Form and receipt of payment. 1-800-424-2460
    NECPA: Submit: Request for Verification Visit Form and receipt of payment. 1-800-505-9878
    NAC: Submit: Request for Validation Visit Form and receipt of payment. 1-800-537-1118
    NAFCC: Submit: Request for Observation Visit and receipt of payment.1-800-359-3817
    NAA: Submit: Request for Endorsement Visit and receipt of payment. 1-800-617-8242
6. Which Program Assessment Tools will be accepted?
    Depending on the type of program you offer and the request you are making you may choose from the following tools.
    Providers should choose a program self-assessment tool that is reflective of the children they serve. Your CCR&R will provide
    technical assistance and funding.

    ♦Centers & Family Child Care Programs♦
    Environment Rating Scales (ERS)
    Environment Rating Scales are assessment tools used to measure and assess the level of quality in a program. Each Environment
    Rating Scale is designed for specific program types and/or age groups. If you are a center based program and have requested
    funding for two or more age groups you must complete an Environmental Rating Scale for each of the age groups served. Family
    Child Care Programs will only need to complete the Family Child Care Rating Scale- Revised (FCCRS-R) or the Family Day Care
    Rating Scale (FDCRS).
               Infant & Toddler Environment Rating Scale Revised (ITERS-R): Ages birth-3 years
               Early Childhood Environment Rating Scale Revised (ECERS-R): Ages 3-5 years
               Family Child Care Rating Scale Revised (FCCRS-R)
               School-Age Care Environment Rating Scale (SACERS): Ages 5-12 years

    Program Administration Scale (PAS)
    A tool for center-based programs to measure the overall quality of management and administrative practices.

    Head Start Program Validation (Head Start Prism)
    Validation by the Administration of Children and Families of compliance with the Head Start Program Performance Standards
    (HSPPS) will be accepted.

    ♦License-Exempt Family Child Care♦
    License-Exempt Family Child Care Checklist
    A program evaluation tool designed for License-Exempt Family Child Care Programs. A copy of this tool is available from your
    CCR&R agency. If you choose, you may complete the Family Child Care Environment Rating Scale Revised (FCCERS-R).




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SECTION 2: THE QUALITY COUNTS GRANT
   7. How do you define Quality Care and how do I need to address it in my program’s grant application?
       Quality child care promotes children’s social, cognitive, emotional and physical development. The 4 indicators of quality care
       applicable to the Quality Counts Grant Program are explained below. These quality indicators need to be addressed when applying
       for the Quality Counts Grant. As an applicant you will need to describe how the items you are requesting funds for will meet and/or
       improve these indicators in your program. These indicators and their relation to the items for which you are applying need to be
       addressed in the narrative section of the grant.

       1.   Relationships. Promoting positive relationships among all children and adults to encourage each child’s sense of belonging and
            independence. Fostering children’s development respective of each family’s composition, language and culture help all children
            succeed. Respectful relationships are inclusive of all children and families backgrounds, interests, and experiences, learning
            styles, needs and capabilities. The quality of these relationships influences the learning and development of children.
       2.   Curriculum and Assessment. A well-planned curriculum with identified learning goals and on-going assessment integrates
            cognitive, social, emotional and physical development. Using multiple teaching approaches that vary from structured to
            unstructured and adult-directed to child-directed maximizes a child’s opportunity for learning.

       3.   Environment. Children reach their learning potential in a healthy, safe, secure and accessible environment. The indoor/outdoor
            environment includes facilities, equipment, and materials to enhance children’s learning experiences.

       4.   Program Management. Effective program management leads to high quality experiences for all children, families and staff. A
            well run program incorporates current technology, professional resources, best business practices, formal education and training,
            effective supervision, and sound policies and procedures.

   8. Who will be reading the grant application and how will it be scored?
       A knowledgeable and impartial panel of readers will be asked to review and score the applications. All steps will be taken to ensure
       reviewers do not have a conflict of interest with your program.

       Your program request will be rated on several criteria including, but not limited to, the following:
             How well your proposal meets the statewide and local priorities.
             Projects that address the needs of children/families receiving child care financial assistance from IDHS.
             Clarity of narrative and complete budget.
             Meeting and exceeding licensing requirements.
             Attendance at the Bidders’ Conference (for the current fiscal year).
       If applicant does not meet all requirements for the Category of funding they are applying for the application will be denied
       and will not be reviewed.

   9. Which grant proposals receive higher consideration?
       Following are the statewide priorities. Addressing a statewide priority is not a requirement; however, grant applications addressing
       any of the statewide priorities will receive higher consideration for funding.
             Increasing the capacity for infants/toddlers.
             Improving the quality of care for infants/toddlers.
             Increasing the capacity for school-aged children (full-year or school-year only).
             Improving the quality of care for school-aged children (full-year or school-year only).
             Creating the ability to accommodate children and families with special needs*.
             Maintaining the ability to accommodate children and families with special needs*.
                 * A child with special needs is a child who has been diagnosed by a professional and receives special services from the
                 public school, a community agency or regular care by a physician for a medical condition.
   10. Which programs receive higher consideration?
       Following are the statewide priorities. Grant applications addressing any of these statewide priorities will receive higher consideration
       for funding.
              Programs that serve children and families receiving IDHS child care financial assistance.
              Full-year/full-day programs (at least 8 hours per day & at least 49 weeks per year).
              Accredited programs or those programs in Accreditation Self-Study.
              Programs that completed a program assessment tool.
              Programs that attend a Bidders’ Conference for the current fiscal year.
              Programs that did not receive a Quality Counts Grant last year.


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   11. Do I have to attend the Quality Counts Bidders’ Conference in order to apply?
       The Bidders’ Conference is one of the most important tools available to assist you in completing and submitting a grant application for
       your program. At the Bidders’ Conference, you will be provided with information on completing the application and given a chance to
       ask additional questions. It is not a requirement to attend, however, a program will receiver higher consideration if you attended.
       There is a high correlation between those who attend a Bidders’ Conference and those who are funded.

       If an agency has multiple sites, at least one person must attend from each site to receive higher consideration. For example, if your
       agency plans to submit three site applications (one application must be submitted specific to each site), three separate individuals will
       need to attend a Bidders’ Conference.

SECTION 3: MAKING THE DECISION TO APPLY FOR A QUALITY COUNTS GRANT
   12. Who can apply for a Quality Counts Grant?
       You must be currently providing child care and:
            Your program MUST be listed in the WC/CCC provider database in order to be eligible for grant funds, regardless of
               openings. You will need to be listed before you submit your application. Please note that the CCR&R provider database is
               not the same as the Child Care Assistance Program (CCAP) database.
            All programs must provide care in one of the following counties: Adams, Brown, Calhoun, Cass, Greene, Jersey, Hancock
               Pike or Schuyler.
   13. What can a program request in a grant?
       Programs may apply for the following type of equipment/supplies: (Not limited to examples listed.)
            Facility Improvement – All Ages: toddler bathroom, fence, egress windows, fire door, etc.
            Equipment/Materials for Children: cribs, child-sized table/chairs, blocks, books, etc.
            Professional Resources: business computer, software, professional development resources, etc.
            Family Resources: lending library materials, parent videos, etc.
            Special Needs: widening doorways to accommodate wheelchairs, handrails for restrooms, etc.
   14. What CAN’T a program apply for?
       All items must be directly related to the safety and quality of your child care services. All items must be new; used items will not be
       accepted. Items you cannot apply for include, but are not limited to: cosmetic home improvements; home additions; non-age
       appropriate items; used equipment; video games and decks; infant walkers; pools; trampolines; televisions; or vehicles.

       Note: Certain items are acceptable for equipment purchases (examples: cell phones, computer, copier, postage machine, etc.);
       however, grant funds CANNOT be used for service contracts on that equipment (examples: cell phone minutes, internet access,
       monthly postage meter charge). Grant funds cannot be used to purchase items from online auctions or for other third-party
       purchases.

   15. Can I submit more than one application? Can I submit one application if my business/agency has more than one
       site?
       Each site/location is considered to be a program. Each program (site) must submit an application requesting what is considered
       specifically needed by that site. (One license = one site = one program = one application.) Programs with multiple sites cannot
       submit identical application forms for each site. You can submit only one grant application per site per application period; however,
       you can request several types of items in one grant application as long as you do not exceed the maximum dollar amount.



SECTION 4: THE QUALITY COUNTS GRANT APPLICATION
   16. What is a complete Quality Counts Application?
       The Quality Counts Grant Application has the following components. You will need to complete each section and provide any
       documentation necessary to be considered for funding.
           1. Contact Information
           2. Proposal Information
           3. Capacity Enrollment
           4. Child Care Financial Assistance
           5. Grant Narrative (See special section below on the Grant Narrative)
                                                         (Continue on next page)
                                                                                                                                         4-6

                                                                       5                                               10/3/2007
          Applicant’s wishing to apply for Category 2 funding will also need to complete:
               6. Category 2 Funding Sheet Attachment A
               7. License-Exempt Family Child Care Checklist Attachment B (License-Exempt Family Child Care Homes only)

     17. What is the page limit for the Narrative section and what should it include?
          Application Narrative:
          You are limited to five (5) double-spaced, typed or hand printed pages for the narrative section. Do not EXCEED five pages. Use
          the narrative outline when writing your responses. The outline will help you remain focused when answering the questions. Your
          attachments for your budget or documents are not counted as part of the five pages. For a list of documents to include, refer to the
          checklist located on page 4 of the application.

          When writing the narrative make sure your answers relate to the improvements you are requesting and how those improvements will
          address one or more of the quality indicators.

          If you are applying for Category 2 Funding you should reference your program self-assessment results or relate how
          additional funding will assist your program in maintaining or receiving accreditation or comply with Head Start standards.

          Submit the required number of copies of completed proposals, including the original. If you intend to attach or include pictures, they
          need to be copied and attached to all copies of the proposal. Also, write your name or your business name on each of the attached
          pages.

     18. How much detail should be provided on the budget?
          For details in completing your budget, please see SAMPLE Budget. If you feel the reviewer of the application may not be able to
          identify the item you listed on your budget, attach a picture or description of the item. For contracted labor work, you must attach at
          least two itemized bid estimates for work and materials and include the bid you selected in your budget.

          Document budget figures carefully, including costs and shipping charges. To estimate taxes and shipping charges:
           If you use the Internet to research your items, the “shopping cart” will usually tell you what the estimated taxes and shipping
               charges will be. Document the source of your estimate.
           If you use a catalog, call the company and ask a customer service representative to provide you with an estimate based on your
               location. Document the source of your estimate.
          Make sure you appropriately indicate the category for the items listed. If the picture description recommends the item be used for
          children 3-5 years of age, and you indicate the item is for infants or toddlers, that item may not be considered.

     19. When should an IDCFS corrective action plan, Fire Marshall documentation, Health Department documentation
         and/or IDCFS licensing standards be attached?
          You need to attach any of these documents to support purchases of equipment that will help you correct deficiencies that were
          addressed in a Corrective Action Plan or that will enable you to become licensed.

          If you are applying for funds to enable you to maintain your current license or assist you in obtaining a license, you will need to submit
          a timeline and plan for the project.

SECTION 5: SUCCESSFUL GRANT WRITING
While it does not guarantee funding, the following section includes helpful information on writing a grant. Please use these suggestions as a
tool to assist you in completing the grant in the most successful way possible.

     20. I’ve never written a grant before, what are some tips?
                •    Attend the Bidders’ Conference
                •    Read the entire grant guidelines & requirements and application thoroughly.
                •    If you do not understand the instructions e-mail or call: Robin at robin@wcccc.com or (217)222-2550
                •    Follow the format and instructions
                •    Use only the original grant application and budget sheets provided. They cannot be recreated.
                •    Answer ALL questions and complete ALL sections.




                                                                          6                                               10/3/2007
                                                                                                                                          4-6
            •    If a question is not applicable, please indicate N/A in space provided.
            •    Use proper grammar with no typographical errors.
            •    Clearly communicate your message without excessive wordiness. Remember, reviewers will be scoring many
                 proposals. Being brief and concise, and including relevant information will be an advantage.
            •    Make sure your narrative addresses the priorities you selected and how each item you request fits into those
                 priorities, quality indicators, and/or self-assessment.
            •    Add details and examples in narrative when addressing priorities, quality indicators and self-assessment.
            •    Submit the required number of copies of completed proposals, including the original. If you intend to attach or
                 include pictures, they need to be copied and attached to all copies of the proposal. Also, write your name or your
                 business name on each of the attached pages.
            •    Do not state assumptions. Back up statements with factual information and data where appropriate. For example:
                 Do not propose to expand an infant program without some documentation of need, waiting lists and/or other
                 information to support your request.
            •    The proposal should be neat and easy to read. Keep the proposal simple (do not use elaborate packaging,
                 expensive folders or spirals). Due to the large quantity of proposals that reviewers will receive, elaborate packaging
                 will be dismantled and is therefore unnecessary.
            •    Complete & submit ALL requested forms and documentations.
            •    Have another person who does not understand your business read your proposal before submitting it. If they
                 understand it, chances are, the reviewers will too.
            •    Use the checklist provided on the last page of the application.
            •    Make sure you complete and SIGN your application.

SECTION 6: FREQUENTLY ASKED QUESTIONS
  21. If the program received a grant last (insert your last grant period) can we apply again?
      Yes, you may apply for a grant during this grant period.

  22. If my program’s grant is approved will the full amount of money requested be received?
      Possibly. Your program’s grant request may be fully or partially funded. The amount of funds available is limited, and the amount of
      funds requested always exceeds the available dollars. The application includes an opportunity for you to explain how you would
      address your full request if we were able to only fund a part of your request.

      A knowledgeable and impartial panel of readers will review your proposal. They will score your proposal on a variety of items, which
      are addressed in other questions in this document. Final scores will help determine who should be awarded funds and how much.

  23. How many grants will be awarded?
      Based on available funding, $111,223 will be distributed through the Quality Counts Child Care Grant Program. The number of
      grants funded depends on the number of proposals received and amounts awarded to successful proposals. We reserve the right to
      award full or partial funding.

      The average award for family child care was $1,080 and $4,413 for centers during the last application period. West Central Child
      Care Connection received 113 requests and was able to fund 70 proposals.
  24. If awarded funding, how does my program receive the funds?
      Typically, all awards are paid on a reimbursement basis. This means you purchase what the award letter specifies, and then submit
      receipts with a reimbursement request form that will be provided to you.
       Any item purchased prior to the award letter date will not be considered for reimbursement.
       Any costs exceeding the award amount are considered out-of-pocket expenses and will not be reimbursed.
       It is possible for us to make a check out directly to the vendor. If you would like us to do that, you can indicate it on the
           reimbursement form. You will need to attach an invoice from the vendor.

  25. Is this a grant or loan?
      This is a grant program, not a loan, which means funds do not generally need to be paid back. However, the grant funds come from
      the State of Illinois, and certain policies and procedures must be followed. The following policies apply:
                                                                                                                                          4-6
          You will not be reimbursed if you fail to provide proof of purchase for the agreed upon expenses within the timeline that will be
           specified in your award letter. (cont.)
          You will have to return items/equipment purchased with grant funds if you go out of business within two (2) years of the date of
           your award. You will need to repay for items that are not easily retrievable (e.g. fence). The amount due will be prorated based
           on the number of months you remained in business following the purchase of items/equipment.
                                                                     7                                              10/3/2007
          If awarded funds, programs cannot substitute items that are not listed in the budget or award letter. Prior approval must be given.
          You will not be reimbursed for items purchased before the date of the award letter, even if the items were requested in your
           proposal.
  25. Do I need to report the grant as income?
      Grant funds may need to be reported as income. If awarded grant funds a completed W-9 form will be required. Items purchased with
      grant money may be eligible to claim as business deductions. Please consult an accountant for further information.

  26. When are proposals due?
      Applications are due to WC/CCC by November 9, 2007 no later than 3:00 p.m. Applications received after the deadline will not be
      considered. Be sure to keep a copy of everything that is submitted. Our agency cannot be responsible for applications lost in the
      mailing process. Any incomplete application will not be considered for funding. Applications sent via mail must be postmarked by day
      stated above.
  27. Can I mail the proposal or bring it to the office?
      If you return the application in person, we will provide you with written verification of the date and time you turned it in. If you mail in
      the application, it is recommended that certified mail/return receipt request be used. You must include the original and 3 additional
      copies of your application and attachments. Be sure to keep a copy of everything that is submitted.
      Each application packet must be in the following order:
                                   (1) Application
                                   (2) Budget
                                   (3) Grant narrative
                                   (4) Supporting documents.
      Category 2 applicants will also include:
                                   (5) Category 2 Funding Sheet Attachment A
                                   (6) License-Exempt Family Child Care Checklist Attachment B (for License-Exempt Family Child
                                         Care Providers Only)
      NO FAXES or EMAILS will be accepted.
  28. When will I know if my program has been awarded funding?
      All applicants will be notified as to whether or not their grant proposal was funded by letter. Award/Denial letters will be mailed out by
      January 31, 2008.


IMPORTANT KEY POINTS TO REMEMBER
     The original application and budget form must be used.
     Keep a copy of all information you submit. Our agency is not responsible for applications lost in the mailing process.
     If awarded funds, you cannot substitute items that are not listed in your budget or award letter. You must seek prior approval.
     Items purchased prior to the date of the award letter will not be reimbursed.
     Original receipts are to be submitted. Keep a copy for yourself.
     Any costs exceeding the award amount are considered out-of-pocket expenses and will not be reimbursed by the program.
     If you do not return receipts or turn in your reimbursement form by the deadline, your funds will be reallocated to another program.
     Grantees who do not adhere to program guidelines will be notified in writing and will be ineligible for future grant programs.

          FOR QUESTIONS ON THE QUALITY COUNTS GRANT APPLICATION PROCESS PLEASE CONTACT:

                                                            Robin Ayers
                                                 West Central Child Care Connection
                                                         robin@wcccc.com
                                                   (217)222-2550 or 800-782-7318




                                                                       8                                                 10/3/2007
                                                                                                                                                                                     4-5
  BUDGET INSTRUCTIONS & SAMPLE
Completing the Budget Form
   • List costs or cost estimates for each item you are requesting (equipment, materials, contracted work, toys, books, etc.).
   • List items in order of need (highest need listed first).
   • Attach two itemized bids or estimates from licensed contractors for contracted work and materials. Use one bid to complete the budget form.
   • All items requested must be NEW and age appropriate.
   • Provide pictures of items as an attachment, if applicable. If you feel the reviewer may not be able to identify the item, attach a picture or description of the item.

             Item:        List the name of the item you wish to purchase.
         Quantity:        List the number of the items you wish to purchase.
    Cost Per Item:        If wanting to purchase more than one item, enter the cost of the single item.
        Sub Total:        Cost of Item times the quantity.
   Shipping/Taxes:        Include taxes and shipping/handling, if applicable.
       Total Cost:        Add the Subtotal and the Shipping/Taxes together.
    Vendor Name:          Where do you plan to purchase the item?
       Categories:        List which category the item will serve.
                          Infants: 6wks - 14mths                         School-Age: Kindergarten - 12 yrs
                          Toddlers: 15mths - 23mths                      All Ages: Appropriate for 3 or more age groups
                          2 Year Olds*: 24mths - 35mths                  Family Resources: Items to support and educate families
                          Preschool: 36mths - 59mths                     Professional Resources: Items to support self and/or staff
                          Facility Improvement – Infant/Toddler: Item that typically addresses safety (toddler bathroom, one-sided mirror, etc.)
                          Facility Improvement – All Other Ages: Item that typically addresses safety (fence, fire door, etc.)
                          Special Needs: Items to accommodate children and families identified with special needs
* Complete two-year old section if your program offers a separate classroom for 2 Year Olds. If not, please enter total items for 15-35 months under Toddlers.

Following is a SAMPLE budget sheet for your reference.                   (Vendor names are fictitious.)

                                                        Cost Per                             Shipping                                                                     Category
               Item                     Quantity                        Subtotal                              Total Cost                 Vendor Name               (list only one category per
                                                         Item                                 /Taxes                                                                           item)
               Crib                          3           $125.00        $375.00                   $0           $375.00                    Curious Kids                     Infants
      Multicultural Dolls                    6            $6.99          $41.94                 $4.99           $46.93                  Our World, Inc.                   Toddlers
    Sand and Water Table                     1           $79.99          $79.99                $19.50           $99.49                  Our World, Inc.                  Preschool
                                                                                                                                                                  Facility Improvement
            Fire Door                        2           $489.00        $978.00                $75.00          $1053.00                    Safe-T First                       –
                                                                                                                                                                     All Other Ages
             Books                          15           $ 14.50        $217.50                 $0              $217.50                The Reading Tree             Family Resources
            Block Set                        2           $45.00          $90.00               $10.00            $100.00                ABC’s and 123’s                    All Ages
              Total                                                                           $109.49          $1891.92


PLEASE TOTAL ITEMS REQUESTED BY CATAGORY. TRANSFER THIS INFORMATION TO PAGE 1 OF YOUR APPLICATION.
         $375.00             Infants                      $ 99.49             Preschool                   $ 0.00              Facility Improvement – Infants & Toddlers
         $ 46.93             Toddlers                     $ 0.00              School-Age                  $1053.00            Facility Improvement – All Other Ages
         $ 0.00              2 Year Olds*                 $100.00             All Ages                    $ 0.00              Professional Resources
                                                          $ 0.00              Special Needs               $ 217.50            Family Resources

                                                                                                                                                                                 Revised 7/06
                                                                                                                                                                                 4-5
                                                                                            ITEMIZED BUDGET
            Please see Sample Budget and “Guidelines & Requirements Question #18 for instructions and assistance. Make additional copies of this form as needed.

                                                                                                                                                                              Category
         Item/Catalog Code                                            Cost Per         Subtotal             Shipping/              Total                                       (list only one
                                                     Quantity                                                                                                   Vendor Name
                                                                       Unit                                  Taxes                 Cost                                        category per
                                                                                                                                                                                    item)

                                                                     $                 $                   $                   $

                                                                     $                 $                   $                   $

                                                                     $                 $                   $                   $

                                                                     $                 $                   $                   $

                                                                     $                 $                   $                   $

                                                                     $                 $                   $                   $

                                                                     $                 $                   $                   $

                                                                     $                 $                   $                   $

                                                                     $                 $                   $                   $

                                                                     $                 $                   $                   $

                                                                     $                 $                   $                   $

                                                                     $                 $                   $                   $

                                                                     $                 $                   $                   $

                                                                     $                 $                   $                   $

                    Total                                                                                  $                   $

PLEASE TOTAL ITEMS REQUESTED BY CATAGORY. TRANSFER THIS INFORMATION TO PAGE 1 OF YOUR APPLICATION.
    $____________ Infants                                         $____________ Preschool                      $____________ Facility Improvement – Infant & Toddlers
    $____________ Toddlers                                        $____________ School-Age                     $____________ Facility Improvement – All Other Ages
    $____________ 2 Year Olds*                                    $____________ All Ages                       $____________ Professional Resources
                                                                  $____________ Special Needs                  $____________ Family Resources

*Complete two-year old section if your program offers a separate classroom for 2 Year Olds. If not, please enter total items for 15-35 months under Toddlers.


                                                                                                                                                                              Revised 7/06
                                                                                                                                                        4-3
                                          QUALITY COUNTS GRANT PROGRAM
                                        CATEGORY 2 FUNDING SHEET ATTACHMENT A

This form is required if you are requesting Category 2 funding, it must be completed and submitted with your grant application. Follow the directions in
each of the four sections carefully. If your program is currently accredited you will need to complete only Section 1. If your program is in the process of
accreditation you must complete Section 2 only. If you are completing a program self-assessment you will need to complete Section 3 only. If you are
a Head Start program complete Section 4 only. Make sure you sign and date this form (page 3).
Section 1: Program Accreditation
If your program has received accreditation, please check the applicable organization listed below. You must attach a copy of your certificate of
accreditation from the accrediting organization. When you have completed this step, sign and date the bottom of page 3 and you are finished.

        Program Accreditation: The process through which child care
        programs voluntarily meet specific standards to receive endorsement   Expiration Date
        from a professional agency.
                                                                              __________
        ___ NAFCC (National Association for Family Child Care)
                                                                              __________
        ___ NAEYC (National Education for the Education of Young Children)
                                                                              __________
        ___ NECPA (National Early Childhood Program Accreditation)
                                                                              __________
        ___ NAA: (National AfterSchool Association)
                                                                              __________
        ___ NAC: National Accreditation Commission of National
           Association for Child Care Professionals
Section 2: Enrollment in Accreditation of Self-Study
If your program is in the process of accreditation you must attach a copy of the following documents along with a receipt of payment from the
accrediting organization. For more information please see the Guidelines & Requirements Questions #4 & #5. When you have completed this step,
sign and date the bottom of page 3 and you are finished.

        Accreditation Self Study: Programs that are in the process of becoming accreditated. See Guidelines & Requirements Questions #4 & #5.

        ___ NAFCC (National Association for Family Child Care)                ___ NAEYC (National Education for the Education of Young Children)
           Submit Request for Observation Visit form along with receipt          Submit acceptance letter into Step 3 Candidacy and receipt of
           of Observation Visit payment.                                         Candidacy payment.

        ___NECPA (National Early Childhood Program Accreditation)             ___ NAA: National AfterSchool Association
           Submit Request for Verification Visit Form and receipt of              Submit Request for Endorsement Visit and receipt of
           Verification Visit payment.                                            Endorsement Visit payment.
        ___ NAC: National Accreditation Commission of National
           Association for Child Care Professionals.
           Submit Request for Validation Visit Form and receipt of
           Validation Visit payment.

Section 3: Program Self Assessment Tools
A program self assessment is an evaluation tool that providers use to determine a programs strengths and areas in need of improvement.
Assessments are based upon observation of the overall program and it’s environment.
Please indicate with an “X” which Rating Scale you chose to demonstrate program self-assessment and enter your scores on the table below in the
following categories.

        Environment Rating Scales (ERS): A program assessment tool used by programs/providers to measure and assess the level of quality in a
        program. See Guidelines & Requirements Question #6. If you are a center program requesting funding for various age groups you must complete
        an Environment Rating Scale for each age group that you are requesting funding.


        ___ FCCERS-R or FDCRS                                                    ___ ITERS (Infant/Toddler Environment Rating Scale) (0 – 3 yr olds)
             (Family Child Care Environment Rating Scale Revised
              Edition or Family Day Care Environment Rating Scale)
                                                                 Score                                                                       Score
        Space & Furnishing / Space & Furnishings                                 Space & Furnishing
        Personal Care Routines / Basic Care                                      Personal Care Routines
        Listening & Talking / Language & Reasoning                               Listening & Talking
        Activities / Learning Activities                                         Learning Activities
        Interaction / Social Development                                         Interaction
        Program Structure / Adult Needs                                          Program Structure
        Parent & Provider / Provisions for Exceptional                           Parents & Staff
                             Children

        Date of Completed Program Assessment:                                    Date of Completed Program Assessment:

                                                                                                                                                          1
                                                                                                                                                               4-3
      Environment Rating Scales (ERS): cont.

      ___ECERS *New (3 – 5 yr olds)                                               ___ SACERS (School Age Care Environment Rating Scale)
         (Early Childhood Environment Rating Scale -Revised)
                                                                Score                                                                            Score
      Space & Furnishing                                                         Space & Furnishing
      Personal Care Routines                                                     Health & Safety
      Language & Reasoning                                                       Activities
      Learning Activities                                                        Interactions
      Interactions                                                               Program Structure
      Program Structure                                                          Staff Development
      Parents & Staff                                                            Special Needs

      Date of Completed Program Assessment:                                      Date of Completed Program Assessment:


      ___ PAS (Program Administration Scale) A tool for center-based programs to measure the overall quality of management and administrative practices.
                     PAS Subscales                                                            Items                                              Score
                                                        Staff Development
      Human Resources Development                       Supervision & Performance Appraisals
                                                        Staff Development
                                                        Compensation
      Personal Cost & Allocation                        Benefits
                                                        Staffing Patterns & Scheduling
                                                        Facilities Management
      Center Operations                                 Risk Management
                                                        Internal Communications
                                                        Screening & Identification of Special Needs
      Child Assessment                                  Assessment in Support of Learning
                                                        Budget Planning
      Fiscal Management                                 Accounting Practices
                                                        Program Evaluation
      Program Planning & Evaluation                     Strategic Planning
                                                        Family Communications
      Family Partnerships                               Family Support & Involvement
                                                        External Communications
      Marketing & Public Relations                      Community Outreach
                                                        Technological Resources
      Technology                                        Use of Technology
                                                        Administrator
      Staff Qualifications                              Lead Teacher
                                                        Teacher
                                                        Apprentice Teacher/Aide

      Date of Completed Program Assessment:

Section 4: Head Start PRISM

      ___ Head Start PRISM (Program Review Instrument for Systems Monitoring of Head Start and Early Head Start Grantees) An evaluation tool
      used by Head Start that reflect a programs strengths & weakness through various areas. Comp = Compliant / Non. Comp – Non-Compliant

                   Sections                                                 Subsections                                    Comp.         Non. Comp
                                              Staffing & Training
                                              Providing Health Services
      Health Services                         Involving Parents
                                              Health Policies & Procedures
                                              EHS Program Serving Pregnant Women or New Mothers
                                              Staffing & Training
      Nutritional Services                     Understanding Children’s Nutritional Needs
                                              Managing Nutritional Services
                                              Integrating Nutrition into Early Childhood Development
                                                                        Continue to next page
                                                                                                                                                           2
Section 4: Head Start PRISM (cont.)
                                                                                                                          4-3

Head Start PRISM (cont.)
            Sections                                          Subsections                             Comp.   Non. Comp
                                    Facilities, Materials & Equipment
Safe Environments                   Hygiene
                                    Food Safety & Sanitation
                                    Staffing & Training
Disabilities Services               Coordinated Activities
                                    Outreach & Recruitment
                                    Evaluation & Development of IEP and/or IFSP
                                    Community Partners
                                     Staffing & Training
Mental Health Services              Implementation of Mental Health Services
                                     Supporting Parents
                                    Staffing & Training
Family & Community Services         Building Relationships
                                    Strengthening Families through the Family Partnership Agreement
                                    Process
                                     Encouraging Parent Participation
                                    Building & Maintaining Community Partnerships
                                    Transportation Services Management
Transportation Services             Grantee & Delegate Directly Provided or Contract - Provided
                                    Transportation
                                    Bus Driver Credentials, Qualifications & Training
                                    Transportation-Related Services
                                    Staffing & Training
Education & Early Childhood         Approach to Education & Early Childhood Development Services
Development                         Providing Education & Early Childhood Development Services
                                    Organizational Capacity
Fiscal Management                   Use of Head Start Grant Funds
                                    Grant Property
                                    Compensation
                                    Financial Reporting
                                    Internal Controls
                                    Program Governance
Program Design &                    Internal Controls
Management                          Shared Decision-Making
                                    Self-Assessment
                                    Ongoing Monitoring
                                    Eligibility, Enrollment & Attendance
                                    Planning
                                    Communications
                                    Record-Keeping Resources
                                    Human Resources

Date of Completed Program Assessment:



                        This must be signed, dated and attached and submitted with your grant application.
                               Make sure you attached any requested documentation to this form.

Applicant’s Signature: ___________________________________________ Date: ____________________
Printed Name: __________________________________________________

Program Name (if applicable): _________________________________________________




                                                                                                                          3

				
DOCUMENT INFO
Description: Child Care Connection Application Form document sample