Prekindergarten Partnership Agreement Notice

Prekindergarten Partnership Agreement Notice

Vermont Agencies of Education and Human Services, Child Development Division
If a prequalified prekindergarten program is unable to provide documentation of insurance coverage at the desired limits, the school districts may complete this form to provide notice to the Agencies of Education and Human Services indicating that they have entered a prekindergarten partnership agreement with a prequalified program that does not have the desired levels of insurance coverage.
School District or Supervisory Union Contact Information
School District or Supervisory Union:*
Contact Name*

First NameLast Name
Title*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Pre-qualified Universal Prekindergarten Program Contact Information
Name*

First NameLast Name
Title*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Insurance Information
What level of insurance does the SD/SU recommend?
- General liability $ * per claim, $ * aggregate
- Sexual Abuse and Molestation $ * per claim, $ * aggregate
- Other insurance coverage *, per claim, $ *, aggregate $ *
What level of insurance does the UPK Partner Program have?
- Broker/Agent: *
- Insurance Provider: *
- General liability $ * per claim, $ * aggregate
- Sexual Abuse and Molestation $ * per claim, $ * aggregate
- Other insurance coverage *, per claim, $ *, aggregate $ *
(Programs are required to general liability coverage by Child Care Licensing.)
What reasons does the Prequalified Universal Prekindergarten Program provide for not obtaining insurance coverage at levels recommended by SD/SU?*

UnavailableUnaffordableOther reason
Provide additional explanation if desired.
Should be Empty:

Prekindergarten Partnership Agreement Notice

School District or Supervisory Union Contact Information

Pre-qualified Universal Prekindergarten Program Contact Information

Insurance Information