Belonging Awards Application Form

The Association of Infant Mental Health in Tennessee is proud to present the 2024 Belonging Awards! Please utilize this link to our website aimhitn.org for glossary of terms, resources, research articles and referral services as you begin this process. We want to give every applicant the opportunity to get support BEFORE applying to ensure you are confident in your inclusion program and able to support the littles you serve. If you need direct assistance, please contact Rion Humphries- Inclusion Advisor at rionh@aimhitn.org.Happy Applying! - Rion Humphries, MSW

Email*

example@example.com

Center or Agency Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

City*

County*

Phone Number*

Please enter a valid phone number.

Contact Name*

First NameLast Name

Contact Email*

example@example.com

What type of DHS Licensed Center is this?*

Family Child CareGroup Child CareChild Care CenterOther

How does your program's philosophy promote inclusive practices?*

How does the staff support the belonging of each child in your center?*

If your center does not have staff, please enter N/A.

How do the administrator(s) support the belonging of each child in your center?*

Number of Full Time Employees*

Number of Part Time Employees*

Do you utilize student workers or volunteers?*

YesNo

In what ways do you ensure different abilities and cultures are represented in the classroom?*

Do you have children enrolled full time? If so, roughly how many?*

Do you have children enrolled part time? If so, roughly how many?*

What materials do you utilize to communicate daily routines?*

How do you serve children who have English as a Second Language?*

Do you have children enrolled with Individualized Family Service Plans (IFSP)? If so, roughly how many?*

Do you have children enrolled with Individualized Education Plans (IEPs)? If so, roughly how many?*

Do you have students who are receiving Child Care Certificates? If so, roughly how many?*

*Child care certificate means a certificate (that may be a check, or other disbursement) that is issued by a grantee directly to a parent who may use such certificate only as payment for child care services or as a deposit for child care services if such a deposit is required of other children being cared for by the provider, pursuant to § 98.30. Nothing in this part shall preclude the use of such certificate for sectarian child care services if freely chosen by the parent. For the purposes of this part, a child care certificate is assistance to the parent, not assistance to the provider; 45 CFR 98.2

What types of specialized training, credentials, or endorsements have you or your staff completed in regard to inclusion?*

Share one example of how you make accommodations or adaptations for a child with a disability in your program and how it has positively impacted the child.*

Has your center/home received support from the CCR&R inclusion coach in your area?*

YesNoOther

Would you be interested in more information about CCR&R inclusion coaching?*

YesNo

Would you be interested in training around inclusion from AIMHiTN and if so, what types of training?*