What is the agency name?
*
What is the site name?
*
Name
*
First Name
Last Name
Email
*
example@example.com
Classroom Information
What are the site's months of operation (ex. Year Round = there are no breaks in the teaching schedule for children or please provide estimated start and end dates for the year)?
*
Ex) Year Round or 8/11 - 5/27
Does this site offer full day and/or part day classes?
*
Full Day Only
Part Day Only
Both Full Day & Part Day
Other
PREK Classrooms
*
Rows
# of PREK Classrooms
(3 years - kinder)
Room Name/Number
Is the classroom CSPP funded?
Session Time
Ex. 7am - 5pm OR 8am-11:30am
PreK
Full day
PreK
Part day (AM/PM)
Provide the regular hours of operation for the site per classroom.
*
What time do most children arrive?
*
Hour Minutes
AM
PM
AM/PM Option
List Classroom Number: All Teacher/Staff names (FIRST & LAST NAME) for the CSPP funded PRESCHOOL classrooms at the site, including split sessions (RM 1: Mickey Mouse & Minnie Mouse, RM 2a: Daffy Duck & Bugs Bunny, RM 2b: Daisy Duck)
*
Do you have CSPP classrooms with 2 year-olds enrolled?
*
Yes
No
List Combined Classrooms
*
Rows
Room Name/Number
# of children enrolled
# of 2 year old children enrolled
Is the classroom CSPP funded?
Room Name/Number
Room Name/Number
Room Name/Number
Room Name/Number
Room Name/Number
Language(s) of Instruction
*
English
Spanish
Mandarin
Other
Additional Information
Provide any logistical information that may be helpful to the assessor on the day of assessment.
Parking Information
*
Please share Street Sweeping day!
Check-In/Entrance
*
Additional Information/Special Accommodations
Save
Submit
Should be Empty: