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FY09 Universal Pre-Kindergarten (UPK) Assessment Planning Grant
Deadline: Your response to this questionnaire must be received by EEC by 4:30 pm on January 28th. The on-line questionnaire is available via the EEC website at Completing the survey on-line is strongly encouraged, but not required. Applicants must choose only one method of submission (on-line or hard copy). Please mail completed questionnaire to:
Attn: Kelly Schaffer
Massachusetts Dept. of Early Education and Care
51 Sleeper St., 4th Floor
Boston, MA02210
Please refer to the FY09 Universal Pre-Kindergarten (UPK) Assessment Planning Grant RFR posted on EEC’s website before completing this questionnaire. As described in the RFR, this questionnaire is the first step in the application process. This data will help demonstrate your eligibility for the grant as well as well as your FY09 grant award amount, if you are selected.
For questions about this questionnaire, please contact Kelly Schaffer at

FY09 Universal Pre-Kindergarten (UPK) Assessment Planning Grant Questionnaire for Independent Family Child Care Providers

Program Name: ______

Program Number: ______

Program Address: ______

Contact Person: ______

Title: ______

E-mail Address: ______

Phone Number: ______

1. As of January 1, 2009, is the FCC program currently accredited by the National Association for Family Child Care (NAFCC)?

If yes:

NAFCC accreditation number: ______

NAFCC accreditation expiration date: ______(mm/yyyy)

1a. Does the provider have a CDA credential or higher (AA, BA, MA, PhD)? ___ Yes ___ No

2.Does the program orprovider currently use the Guidelines for Preschool Learning Experiences to plan the curriculum and Early ChildhoodProgram Standards for Three and Four Year olds(Program Standards do not apply to family child care) to plan the curriculum andactivities for preschool children?___ Yes ___ No

3. Does the program or provider currently use, or plan to use, one of the four EEC-approved assessment instruments (Work Sampling, Creative Curriculum Developmental Continuum, High Scope Child Observation Record (COR), or Ages and Stages) to assess preschool children in the program? ___ Yes ___ No

4.Which one of the four EEC approved assessment instruments is currently used to assess preschool children in the program, or if your program is not yet using a tool, which tool is your program committed to using? (Check one)

____ Work Sampling

____ Creative Curriculum

____ High Scope COR

____ Ages & Stages

5.If applicable, when did the program start using this assessment tool? This means that your staff has been trained in use of the tool and have completed at least one observation period. (If not yet started, enter "Not started.")

Date Started: ______(mm/yyyy)

6.If you have been using an assessment tool for more than one year please justify why you are seeking funding (200 words maximum).

______

Please reply with information regarding the entire program at this site as of January 1, 2009.

Provider's Highest Degree obtained: (check one)___ HS diploma/GED

___ CDA

___ AA

___ BA/BS

___ Masters

___ Doctorate

___ No Degree

Assistant Provider's Name: (if applicable) ______

Assistant Provider's highest degree obtained: ___ HS diploma/GED

___ CDA

___ AA

___ BA/BS

___ Masters

___ Doctorate

___ No Degree

7a. Number of hours per day your program operates: ____

7b. Number of days per week your program operates: ____

7c. Number of weeks per year your program operates: ____

8. Number of preschool children (2.9 years until Kindergarten eligible) enrolled in this home: ____

9. Number of preschool children (2.9 years until Kindergarten eligible) in this system whose enrollment is funded through EEC Financial Assistance (Vouchers, Contracts, or CPC funding), Head Start, or private scholarship. Please only count each child once (by primary funding source): ____

9a.Does the program fund children through private scholarships? ___ Yes ___ No

If Yes,

9b.Is the criteria for private funding based on income? ___ Yes ___ No

If Yes,

9c. Please indicate gross monthly income for a family of three to be eligible for private funding: ____ $5,316/month or less ____ $5,316/month or more

12.If program site does not provide full-day, full-year service, how does the program support families to meet this need? (Check all that apply)

___ Contract with another provider to offer the service

___ Another provider offers extended day service at program site

___ Referrals made

___ Other

___ Do not offer this coordination

Massachusetts Department of Early Education and Care – January 2009