Provider of the Year Application Due by the 30th of November every year.

Week of the Family Child Care Provider Application Form


Name of Provider ________________________________________________

Address, City, Zip ________________________________________________

Telephone Number __________________
E-Mail ____________________________________

Points
_____ 1. Number of Years in family childcare (5 points maximum)
_____ 3-5 years (1 point)
_____ 6-10 years (3 points)
_____ over 10 years (5 points)

_____ 2. Are you a member of? (7 points maximum)
_____ Professional Providers of Duluth (mandatory) (1 point)
_____ State Association (MLFCCA) (1 point)
_____ National Association (NAFCC or other) (1 point)
_____ Please specify position and organization if you were a board member (2 points), a committee chair (1 point), or committee volunteer (.5 point) for one of the above associations within the last 5 years (Maximum 3 points)
__________________________________________________________________
__________________________________________________________________
_____ Other: DAEYC
Volunteer time (Crisis Nursery, church, school, etc. 1 point)

_____ 3. What training have you received (10 points maximum)
_____ Early Childhood Degree (4 points)
_____ College Child Development Certificate (3 points)
_____ CDA, CBTA or other recognized accreditation (2 points)
_____ Other Early childhood related College Courses (2 points)
_____ More than 10 hours of training each year (1 point)
_____ Other: Explain_______________________________________ (1 point)

_____ 4. How is your program enriched? (1 point each, maximum 4 points)
_____ Purchased preschool program
_____ Develops own preschool program
_____ Outreach with Children (i.e. field trips, food shelf, etc)
______Other: Explain______________________________________

_____ 5. Returned form to PPD (2 points)

_____ 6. Letters from Parents (2 points each, maximum of 6 points)