Provider Storm Closure Status
In order to better serve our children, families, and providers, please complete the information below.
Child Care Business Name:
*
Provider EFS ID Number:
*
Point of Contact:
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Please provide the date your program closed.
Please provide the date you expect to reopen:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Number of SR Enrollments:
Number of VPK Enrollments:
Please include any additional comments if necessary.
Submit
Should be Empty: