Spark Rating Renewal Form #4 Collaborative Continuous Quality Improvement Activities
Complete this form to renew your Spark rating if you have chosen Option 4, Collaborative Continuous Quality Improvement Activities. This form is to document goals achieved as a result of collaboration with a professional from an outside agency such as a Quality Improvement Specialist, mentor or coach. Information about rating renewal can be found at:
Current Star Rating
Name of Person Completing Form (if different)
Name of the Quality Improvement Specialist (QIS)/coach/mentor
Phone # of QIS/coach/mentor
When did you begin working with them? (approximate date is OK)
Email Address of QIS/coach/mentor
What types of goals were identified? For example, changes to the program environment, new or updated policies, changes in program practices. Check all that apply below.
Adult child interactions
Other (use the box below to address the type of goals)
Please enter the type of goals if you selected "Other"
Describe how you achieved one goal in your program. Please Include photos if applicable and attach additional pages if necessary.
Upload photos if applicable. You can upload up to 5 files
Which Spark domain(s) did this fall under?
Learning & Development
Health & Safety
Administration & Business Practices
Date of Completion