Spark Program Update Report

Thank you for your program’s participation in Spark, Oregon’s Quality Recognition and Improvement System. Please complete this Spark Program Update Report (SPUR) to ensure your information is up to date and to share more information about continued participation in Spark.

It is also used to request rating reinstatements when programs become eligible, request updated certificates, and receive information on rating renewal activities.

Completing this report is also one of the components needed to stay in good standing with Spark. Being in good standing is required to be eligible for future Spark opportunities, such as additional funding.

The Spark Program Update Report will collect information on:

Your program and children served in your program
Continuous Quality Improvement
Commitment to maintain quality standards

The Spark Program Update Report also provides you an opportunity to:

Reflect on quality improvement goals achieved
Identify activities to achieve goals
Share your intent to advance to a higher rating

A. Program Information Update/Verification

What is the purpose of completing this report? (choose all that apply) *

1. Updating information - there has been a change or it's been more than a year since we completed a SPUR or submitted an application or portfolio.

2. Updated certificate needed showing my rating is current. (If your rating has expired, you will be emailed a 3-month temporary certificate and information about completing a Rating Renewal to receive a 12-month extended certificate)

3. I would like to have my program's star rating reinstated after a revocation.

4. I need a replacement portfolio.

5. I would like to request a rating transfer due to a license number change.

6. Requested by TRI staff for a Rating Maintenance.

1. Program Name (Submit a separate report for each physical location) *

2. My program is *

Licensed

License Exempt

3. License Number: *

4a. Location Address *

4b. Location City *

4c. Location State *

4d. Zip Code *

5. Same as mailing address? *

Yes

No

6a. Mailing Address

6b. Mailing City

6c. Mailing State

6d. Mailing Zip Code

7. Location County (choose from list) *

8. Is your program accredited by an outside accrediting agency? (not licensing) *

Yes

No

9. Check accreditation type:

NAEYC	NAFCC
ASCI	Other Other

10. Other Program Type: (check all that apply) *

11a. Director's/Provider's First Name *

11b. Director's/Provider's Last Name *

12. Director's/Provider's Phone # (###-###-####) *

13. Director's/Provider's E-mail address *

14. Is the director/provider also the contact for Spark? *

Yes

No

15a. Spark contact first name

15b. Spark contact last name

16. Spark contact phone # (###-###-####)

16b. Can this number receive text messages related to Spark? *

Yes

No

16c. Spark cell phone for receiving text messages (###-###-####)

17. Spark Contact e-mail address

18. Are there children with disabilities in the program? *

Yes

No

19. How many children with disabilities in the program?

20. Are there children on IFSP/IEPs in the program? *

Yes

No

21. How many children on IFSP/IEPs in the program?

22. Total number of staff who work directly with children: *

23. Primary language/s of children served. *

24. Indicate the age groups served by your program and the number currently enrolled in each group. Estimate if needed. (Each individual field is required) *

	Is age group served? (Type Y or N)	Number currently enrolled or "0"
6 weeks - 17 months	Is age group served? (Type Y or N)	Number currently enrolled or "0"
18 months - 35 months	Is age group served? (Type Y or N)	Number currently enrolled or "0"
3 year olds	Is age group served? (Type Y or N)	Number currently enrolled or "0"
4 year olds	Is age group served? (Type Y or N)	Number currently enrolled or "0"
5 year olds	Is age group served? (Type Y or N)	Number currently enrolled or "0"
6-12 year olds	Is age group served? (Type Y or N)	Number currently enrolled or "0"

None	Preschool Promise
Baby Promise	Head Start
School Age only	Relief Nursery
Focused Network	Other Other