ASPIRE TO INSPIRE STARS INITIATIVE APPLICATION

ASPIRE TO INSPIRE STARS INITIATIVE APPLICATION
Welcome, Keystone STAR 1 Providers! We're so glad you're here. This application is specially designed to support STAR 1 providers on the path to achieving Keystone STAR Level 2. If you're already a STAR 2, 3, or 4 provider, your journey continues with our trusted partners at First Up through their E.Q.U.I.P. program. To learn more visit: https://www.firstup.org/equip/.
PROGRAM ELIGIBILITY
What is your current Keystone STARS level?*

Keystone STARS Level 1Keystone STARS Level 2Keystone STARS Level 3Keystone STARS Level 4
This Application is for Keystone STAR Level 1 Providers only. Since you selected STAR Level 2, 3, or 4 your journey continues with our trusted partners at First Up through their E.Q.U.I.P program. To learn more visit: https://www.firstup.org/equip/
Please complete this section with accurate and detailed information about your early childhood program. The provided details will assist us in tailoring support and resources to address your specific needs as part of the Aspire to Inspire Keystone STARS Initiative.
FACILITY
Name of Facility: [Enter legal name as it appears on the DHS Certificate of Compliance]*
Location Name(s): [List all location names associated with the facility]*
Address: [Enter facility's complete address]*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone: [Enter facility's main contact phone number]*
Format: (000) 000-0000.
Director Name: [Enter name of the facility's director]*

First NameLast Name
Director Email: [Enter email address of the facility's director]*
Director Cell Phone Number: [Enter the mobile phone number of the facility's director]*
Format: (000) 000-0000.
PA PD Registry ID#: [Enter the Pennsylvania Professional Development Registry ID# of the facility]*
MPI #: [Enter the Master Provided Index Number issued by the Pennsylvania Department of Human Services (DHS)]*
How long has the current director been in their position?*

Less than 1 year1-3 years3-5 years5-10 yearsMore than 10 years
Type of Facility (Center-Based, Family Child Care Home, Group Child Care Home):*

Family Child CareGroup Child CareCenter - Based
How many sites are moving to STAR Level 2?
[Repeat the above section for each additional site moving to STAR Level 2, if applicable.]
Site 2:
Contact Person/Director Name:*

First NameLast Name
Email Address:*
Mobile/Cell Phone Number:*
Format: (000) 000-0000.
Type of Facility (Center-Based, Family Child Care Home, Group Child Care Home):*

Family Child CareGroup Child CareCenter - Based
Site 3:
Contact Person/Director Name:*

First NameLast Name
Email Address:*
Mobile/Cell Phone Number:*
Format: (000) 000-0000.
Type of Facility (Center-Based, Family Child Care Home, Group Child Care Home):*

Family Child CareGroup Child CareCenter - Based
Site 4:
Contact Person/Director Name:*

First NameLast Name
Email Address:*
Mobile/Cell Phone Number:*
Format: (000) 000-0000.
Type of Facility (Center-Based, Family Child Care Home, Group Child Care Home):*

Family Child CareGroup Child CareCenter - Based
Site 5:
Contact Person/Director Name:*

First NameLast Name
Email Address:*
Mobile/Cell Phone Number:*
Format: (000) 000-0000.
Type of Facility (Center-Based, Family Child Care Home, Group Child Care Home):*

Family Child CareGroup Child CareCenter - Based
Moving to Keystone STARS 2:
Are you currently receiving support from another organization to move toward STAR 2?*

YesNo
If yes, what is the name of the organization?
Have you participated in an Aspire to Inspire STARS cohort before?*

YesNo
What is the status of your license?*

ProvisionalLicensed
Getting to Know Your Program

This section aims to gather essential information about your early childhood program as part of the Aspire to Inspire Keystone STARS Initiative. Please provide accurate and detailed responses to the following questions to help us better understand your program and support you in your quality improvement journey.
1. Program Description:
Briefly describe your program, including the ages of children served, program philosophy, and any unique features or specialized curriculum.*
2. Program Goals:
Briefly describe your program’s short-term goals.*
Typically 6 months - 1 year goals
Briefly describe your program’s long-term goals.*
Typically 1 - 3+ year goals
In your own words, how do you define high-quality in early childhood education?*
3. Program Schedule:
Provide an overview of your program's operating hours and days of operation. Include any information about full-day or part-day schedules and any flexibility in scheduling options.*
4. Staffing:
a) Number of Staff: How many staff members are currently employed in your program?*
Number of Full-time staff:*
Number of Part-time staff:*
How many staff members in your program hold the following qualifications?
Masters degree in early childhood or related field:*
Bachelor degree in early childhood or related field:*
Associate degree in early childhood or related field:*
Child Development Associate (CDA) Credential:*
High School Diploma/GED:*
No Credentials*
Program Environment:

How many classrooms and number of children each classroom can hold
Number of Infant Classrooms:*
Maximum Number of Infants:*
Number of Young Toddler Classrooms:*
Maximum Number of Young Toddlers:*
Number of Older Toddler Classrooms:*
Maximum Number of Older Toddlers:*
Number of Pre-Kindergarten (3-5) Classrooms:*
Maximum Number of Pre-Kindergartens (3-5):*
Number of Young School-Age Classrooms:*
Maximum Number of Young School- Age Children:*
Number of Older School-Age Classrooms:*
Maximum Number of Older School - Age Children (3-5):*
Which curriculum is your program currently using (if any)?*

Creative CurriculumMontessoriBright WheelHigh ScopeFun ShineStill exploring curriculum optionsOther
Are you currently using any childcare self-assessment tools?*

ECERS (Early Childhood Environment Rating Scale)ITERS (Infant Toddler Environment Rating Scale)FCCERS (Family Child Care Environment Rating Scale)SACERS (School-Age Care Environment Rating Scale)BAS (Business Administration Scale)PAS (Program Administration Scale)CLASS (Classroom Assessment Scoring System)Strengthen FamiliesAll of the aboveNone of the above
Parent Involvement:
How do you involve parents in your program? Provide examples of activities, events, or initiatives that encourage parent participation and engagement.*
Community Partnerships:
Do you have any existing partnerships or collaborations with community organizations or resources? If so, briefly describe these partnerships and their role in supporting your program.*
Please list any local and/or national organizations you are apart of (if any).*
Program Challenges and Strengths:
Identify the main challenges your program currently faces and any significant strengths or accomplishments that set your program apart.*
Does your facility have a COVID-19 and Health and Safety Plan in place?*

Yes, we have a comprehensive COVID-19 and Health and Safety Plan.Yes, we have a basic COVID-19 and Health and Safety Plan.No, we do not have a specific COVID-19 and Health and Safety Plan.We are currently in the process of developing a COVID-19 and Health and Safety Plan.
Does your facility have a Continuous Quality Improvement (CQI) Plan in place?*

Yes, we have a well-established Continuous Quality Improvement Plan.Yes, we have a basic Continuous Quality Improvement Plan.No, we do not have a specific Continuous Quality Improvement Plan.We are currently in the process of developing a Continuous Quality Improvement Plan.
Does your facility have any identified professional development needs?*

Yes, we have identified specific professional development needs.Yes, but our professional development needs are not clearly defined.No, we do not have any identified professional development needs at the moment.
If yes, please briefly describe:*
How Did You Hear About The Aspire To Inspire STARS Initiative?*
By submitting this application, Attestation: we affirm that all the information provided is accurate and complete to the best of our knowledge. We understand that participation in the Aspire to Inspire Keystone STARS Quality Initiative is voluntary, and we commit to meeting the requirements and standards set forth by the Aspire to Inspire: Keystone STARS Quality Initiative. We affirm that as of the date below, the legal entity associated with this DHS Certificate of Compliance is currently in good standing. We acknowledge that we hold at least a New Child Care Provisional License and have achieved STAR 1 status. I understand the importance of notifying the Kimble Group promptly if there are any changes to our licensing or STARS status. Failure to do so may result in suspension and, in severe cases, termination from the Aspire to Inspire Keystone STARS Quality Initiative. Additionally, I acknowledge and understand that the administrators, consultants, trainers, mentors, and all other staff at theKimble Group are mandated reporters, obligated to report any suspected cases of abuse to theDepartment of Human Services (DHS).
Signature:*

[Person Legally Responsible or Authorized Representative]
Date:*

MonthDayYear
Date
Should be Empty:

ASPIRE TO INSPIRE STARS INITIATIVE APPLICATION

PROGRAM ELIGIBILITY

This Application is for Keystone STAR Level 1 Providers only. Since you selected STAR Level 2, 3, or 4 your journey continues with our trusted partners at First Up through their E.Q.U.I.P program. To learn more visit: https://www.firstup.org/equip/

Please complete this section with accurate and detailed information about your early childhood program. The provided details will assist us in tailoring support and resources to address your specific needs as part of the Aspire to Inspire Keystone STARS Initiative.

FACILITY

Site 2:

Site 3:

Site 4:

Site 5:

Moving to Keystone STARS 2:

Getting to Know Your Program

1. Program Description:

2. Program Goals:

3. Program Schedule:

4. Staffing:

How many staff members in your program hold the following qualifications?

Program Environment:

Parent Involvement:

Community Partnerships:

Program Challenges and Strengths: