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ECE Provider Update Form
We work hard to maintain the most comprehensive and up-to-date child care database possible so we can better serve the parents, child care providers, and communities in our region. Please take a few moments to complete the following form to ensure we have accurate information about your program. When changes occur (openings, etc.) please return to this page to send us updates.
If you prefer, you may print the form and mail or fax it to us, or just give us a call at 1-800-577-2276 and we can update your file over the phone. We are here to serve you.
Please complete our Provider Update form below.
 

DIRECTOR OR PROVIDER'S CONTACT INFORMATION

First Name
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Last Name
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Business Name
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Street Address
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Unit #
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Address Line Two
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County
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City
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State
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Zip Code
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+
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MAILING ADDRESS (If different than location address)

Street Address
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Unit #
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Address Line Two
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Primary Phone
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Ext
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Secondary Phone
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Ext
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Email Address
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Fax
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Web Site URL
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LICENSE INFORMATION

Type of Care
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License Type
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License ID
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Expiration Date
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ACCREDITATION

Accreditation
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If "OTHER", please specify
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CENTER NON-PROFIT STATUS

Center Non-profit Status
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FACILITY SETTING

Mark if your facility is physically located in one of these settings
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ACCEPTED AGE RANGE

From
Years
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Months
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Weeks
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To
Years
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Months
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Weeks
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CAPACITY

Total Licensed Capacity (what is on your license)
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Total Desired Capacity (how many will you actually take?)
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Licensed Capacity by Age Group
Infants
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Toddlers
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Preschoolers
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Schoolagers
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Desired Capacity by Age Group
Infants
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Toddlers
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Preschoolers
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Schoolagers
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CURRENT VACANCIES

Total Vacancies
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Vacancies per age group
Infants
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Toddlers
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Preschoolers
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Schoolagers
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AVAILABILITY

Accepts Children
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Duration
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Number of Shifts/Session
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DAYS CARE PROVIDED

Rates for Infant
Hourly Full-Time
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Hourly Part-Time
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Weekly Full-Time
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Weekly Part-Time
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Rates for Toddler
Hourly Full-Time
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Hourly Part-Time
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Weekly Full-Time
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Weekly Part-Time
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Rates for Preschool
Hourly Full-Time
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Hourly Part-Time
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Weekly Full-Time
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Weekly Part-Time
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Rates for School-age
Hourly Full-Time
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Hourly Part-Time
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Weekly Full-Time
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Weekly Part-Time
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Monday
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Start Time
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End Time
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Tuesday
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Start Time
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End Time
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Wednesday
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Start Time
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End Time
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Thursday
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Start Time
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End Time
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Friday
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Start Time
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End Time
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Saturday
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Start Time
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End Time
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Sunday
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Start Time
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End Time
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Additional Fees
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If "Other", please specify
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Notes and Comments
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PROGRAMS INCLUDED IN YOUR SERVICE

Programs
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School District(s) Served (list, separated by comma)
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Transportation
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ENVIRONMENT

Environment
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Type of Pets
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MEALS

Meals
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PROGRAM PHILOSOPHY

Program Philosophy
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If "Other", please specify
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FINANCIAL ASSISTANCE ACCEPTED OR PROVIDED BY YOUR PROGRAM

Financial Assistance
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STAFF SPECIAL NEEDS TRAINING OR EXPERIENCE

Staff Training
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If "Other", please specify
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EDUCATION (Family Child Care Providers Only)

Education
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PROGRAM AFFILIATION (mark if you are affiliated with any of the following)

Program Affiliation
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If "Other", please specify
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STAFF BENEFITS AND DEMOGRAPHICS (for statistical purposes only)

Staff Benefits
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Number of persons on staff who are Spanish/Hispanic/Latino:
Mexican, Mexican American, Chicano
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Puerto Rican
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Cuban
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Other
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If "Other", please specify
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Number of persons on staff who's race is:
White
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African-American
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American Indian or Alaskan Native
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If "American Indian or Alaskan Native", please specify tribe
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Asian Indian
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Native Hawaiian
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Filipino
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Japanese
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Somoan
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Vietnamese
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Guamanian or Chamorro
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Chinese
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Other Asian
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If "Other Asian", please specify race
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Other Pacific Islander
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If "Other Pacific Islander", please specify race
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Other
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If "Other", please specify race
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Number of persons on staff who speak a language other than English at home
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What Languages
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