Spark Rating Renewal Form #3: On-site Observation Reporting (Post-Observation)

Complete this form to renew your Spark rating if you have chosen Option 3, On-Site Observation. The observation needs to have been completed within the past 12 months. This form is to describe on how you used the feedback from the observation to make changes to your program. Include a copy of the observation summary. Information about rating renewal can be found at: https://oregonspark.org/current-participants/

Date * +

Program Name *

Provider Name *

License Number

Not Licensed

Current Star Rating *

Contact Number *

Phone Type

Cell

Office

Home

Email Address *

Name of Person Completing Form (if different)

Name of Person/Agency that Conducted Observation *

Date of Observation (Must be within 12 months) * +

Type of Observation Conducted *Include Copy of Observation Summary *

CLASS (Classroom Assessment Scoring System)

ERS (Environment Rating Scale)

Upload the Copy of Observation Summary *

Describe how you addressed one growth opportunity in your program. Please include photo if applicable. *

Upload photos if applicable: You can upload up to 5 files.

Which Spark domain(s) did this fall under? *

Signature *

clear

Date of Completion * +

Learning & Development	Health & Safety
Personnel Qualifications	Family Partnerships
Administration & Business Practices