Healthy Child Care Success Stories

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Question Title

* Information about Your Program

Program Name *

Address 1 *

Address 2

City *

State *

Zip *

Email Address: *

Phone Number:

Question Title

* County

Question Title

* Total Enrollment:

Question Title

* Total High-Need Enrollment:

*High-need children are those who are from low-income families or otherwise in need of special assistance and support, including children who have disabilities or developmental delays, who are English learners, who are migrant, homeless, or in foster care or who reside on "Indian lands", as that term is defined by Section 8013(6) of the Elementary and Secondary Education Act, of 1965.

Question Title

* Please check the ages of children enrolled (Check all that apply):

Infant

1 Year

2 Years

3 Years

4 Years

5 Years

Question Title

* Program Description (Check all that apply):

For-Profit

Not-for-Profit

Head Start/Early Head Start

GSRP

Montessori

Other Licensed Program

Other, please specify

Question Title

* Information about You

First Name *

Last Name *

Job Title *

NAP SACC Consultant? (Yes/No) *

Phone

Email Address *

CAREFUL
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