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Required format:

5YMoQw3Y2XzFHHYLEuYySaiwQj66WyzUZGK93T2Vr3fnwwIGUqmPcMChcKyXMCyqkA8Pw

Childcare Center Information

REACH is a training program for early childhood providers. It is designed to increase staff capacity to support positive mental health and improve behavioral outcomes of young children. REACH is funded through the DCCECE and comes at no cost to child care providers. REACH trainers come to your community or center each month over a 6 month period. The program includes 2 director workshops and 6 teacher workshops. It also includes follow-up coaching to support teachers in practicing skills learned at the workshops. Centers partnering with REACH will also receive a toolkit each month with materials associated with training at no cost. In order to be considered as a REACH center, we need some basic information first.

You will probably want to be at your desk when you fill this out and have your personnel files ready, as we will be asking about staff education, training, etc. Thank you for taking the time to complete these start up forms!

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Today's Date:

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M-D-Y

Center Name:

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Center Address:

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Center City:

* must provide value

Center State:

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Center County:

* must provide value

Center Zip Code:

* must provide value

Center Phone:

* must provide value

Facility Number:

* must provide value

Director's Name:

* must provide value

Director's email:

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Cell Phone:

Office Phone

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How do you prefer to be contacted?

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Office phone

Cell phone

How did you hear about REACH?

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Total number of classrooms:

* must provide value

Total number of teachers:

* must provide value

What age groups does your center serve? (Check all that apply)

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Infant

Toddler

Preschool

School Age

Please list below the number of each type of classroom you have at your center. If you do not have any classrooms for that age group, enter 0.

Number of infant rooms:
Number of toddler rooms:
Number of preschool rooms:
Number of school age rooms:

Please tell us more about the composition of your center. For example, if you predominately serve one age group, have combined infant-toddler rooms, are a Family Child Care Home, etc.

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Days of Operation (check all that apply)

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Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Annual Schedule

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12 month program

9 month program

Other

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Please describe other:

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Please describe any special issues (such as children in shelters or foster care, those with special healthcare needs, etc.):

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Program Funding sources (check all that apply):

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ABC

Head Start

Early Intervention Day Treatment (EIDT)

Private Pay

Low Income vouchers

Foster Care vouchers

Other funding

Please describe other funding source

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If ABC, is your program within a school district?

* must provide value

Yes

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If yes:

Name of school district:
Number of infant rooms:
Number of toddler rooms:
Number of preschool rooms:

What percentage of your enrollment are low income vouchers? If you are unsure of the exact number, please provide your best estimate.

* must provide value

Change the slider above to set a response

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What percentage of your enrollment are foster care vouchers? If you are unsure of the exact number, please provide your best estimate.

* must provide value

Change the slider above to set a response

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Is your center a licensed family child care home?

* must provide value

Yes

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Quality Rating Improvement System-Better Beginnings Status:

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Not yet enrolled

Application in process

Level 1

Level 2

Level 3

Level 4

Level 5

Level 6

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Please list the approximate number of staff in each category and the turnover you have had in the past year. For example, you may have 10 lead teachers now, and 2 of those teachers quit and were replaced. If you are unsure of the exact number, please provide your best estimate. If a category does not apply to your center, please enter 0.

	Total number now	Number who quit or were fired in the past year
Lead teachers
Assistant teachers
Supervisors (director, assistant director, site supervisor, etc.)
Support staff (administrators, transportation, kitchen, etc.)

What is the most common credential for your Lead teachers?

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High school diploma or GED

Associate's degree

Child Development Associate (CDA)

Bachelor's degree

Master's degree

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What percentage has none of the above? If you are unsure of the exact number, please provide your best estimate.

Change the slider above to set a response

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Please list any other specific requirements for your lead teachers (for example, lead teachers have to be certified, etc.):

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What is the most common credential for your Assistant Teachers?

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High school diploma or GED

Associate's degree

Child Development Associate (CDA)

Bachelor's degree

Master's degree

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What percentage has none of the above? If you are unsure of the exact number, please provide your best estimate.

Change the slider above to set a response

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Please list any other specific requirements for your assistant teachers (for example, assistant teachers have to be certified, etc.):

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How many of your current staff have completed each of the trainings below? If you are unsure of the exact number, please provide your best estimate. If none of your staff have completed the training listed, enter 0.

Training	Number of staff completing
Social-Emotional Learning (SEL) 45-hour training
Conscious Discipline-Infant-Toddler (24 hours)
Conscious Discipline-Preschool (36 hours)
Conscious Discipline-Conscious Discipline Connection (20 hours)
Conscious Discipline-10 Steps to Positive Discipline (5 hours)
Powerful Interactions
Making First Experiences Count
REACH (6-month training/coaching series)
Other trainings

Please describe other social-emotional trainings and the number of staff that have completed them. If you are unsure of the exact number of staff who have completed the training(s), please provide your best estimate.

Description of Other Trainings	Total number of staff that completed

Which of the following supports have occurred within your facility in the past two years? (please check all that apply)

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ITERS and/or ECERS observations

Assistance with Better Beginnings application

BehaviorHelp

Technical Assistance through A-State Childhood Services

Other supports

I have not received any supports in the last two years.

Please describe other supports:

* must provide value

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How hard would it be for staff to find time to meet or visit with a trainer or coach on a regular basis?

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Not hard

Would be hard but possible

Very hard, probably not possible

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How hard would it be for all staff to attend training?

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Not hard

Would be hard but possible

Very hard, probably not possible

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Do you prefer in-person or virtual training?"

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in-person

virtual

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Which of the following would be serious barriers to organizing training for all staff? (Check all that apply.)

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Hours staff would be available for training

Ability to pay overtime

Ability to hire subs

Ability to require mandatory training

None of the above

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