What is the agency name?
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What is the site name?
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Name
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First Name
Last Name
Email
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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)?
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Ex) Year Round or 8/11 - 5/27
Does this site offer full day and/or part day classes?
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Full Day Only
Part Day Only
Both Full Day & Part Day
Other
PREK Classrooms
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# 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. .
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What time do most children arrive?
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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)
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Language(s) of Instruction
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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
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COVID-19 Protocol/Restrictions
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Additional Information/Special Accommodations
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