Program Application – End of Year 2014-2015 (FCC) ECWP End of Year Forms End of Year Program Application (FCC) 14-15 End of Year Program Application (Center) 14-15 ECWP Enrollment Forms W-9 Program Application (FCC) 14-15 Program Application (Center) 14-15 Participant Expectations 14-15 KDHE Licensing Verification 14-15 Application of INTEREST 14-15 Agreement to Participate 14-15 ECWP ERS Forms ERS Overall Scores 14-15 ECWP Grant Forms & Resources W-9 Grant ERS Page (ITERS-R) Grant Information & Instructions 14-15 Grant Budget Summary Report 14-15 Grant Budget Addendum 14-15 Grant Application 14-15 ECWP NAP SACC Forms & Resources Go NAP SACC Screen Time Go NAP SACC Outdoor Play & Learning Go NAP SACC Infant & Child Physical Activity Go NAP SACC Child Nutrition Go NAP SACC Breastfeeding & Infant Feeding ECWP Orientation Forms & Resources Orientation Report & Sign-In 14-15 Individual Orientation Documentation 14-15 Orientation PDE Orientation Orientation - Trainer Instructions Orientation Certificate 14-15 Orientation Approval Letter Contact Information Email Address * Program Name * Contact Person Name * Specialist CCR&R Street Address * City * Country * State * Zip Code Currently Enrolled? * Yes No Program Enrollment Information Program Enrollment Information Licensed Day Care Group Day Care 0 - 11 months 12 - 17 months 18 - 23 months 24 - 36 months Total Preschool 37 months - 5 years Total School-Age (6+ years) Total FCC Enrollment (all children) DCF (SRS) Children (those receiving subsidy) 0 - 11 months 12 - 17 months 18 - 23 months 24 - 36 months Total Preschool 37 months - 5 years Total School-Age (6+ years) Total DFC Enrollment Education Level Education Level GED Highschool Currently working toward CDA CDA Credential Associates Degree Bachelors Degree Masters Degree Ph. D Major Minor CDA Credential Info (if applicable) CDA Credential Type Family Child Care Infant Toddler Preschool Home Visitor Credential Date Awarded Credential Expiration Date Credential Renewal Date How many professional development hours (any and all training hours) did you attend this year (2014-2015)? List any significant changes that the program has made in the past 12 months (change of director, opening/closing classrooms, moving locations, major renovation, etc.): Describe how grant funds were used in your program? If you are human, leave this field blank.