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INTEREST FORM: Rural Early Learning Facility Improvement Grant

Completing this application does not guarantee you will be invited to participate in this grant opportunity.

Which county is your program located in? *

Does your program provide full-day, full-year child care services? Full-day, full-year services are defined as at least 6 hours per day, five days per week, minus planned closures for major holidays, etc. *

Yes, currently

Yes, I'm committed to providing full-day, full-year care

No, I'm not willing to provide full-day, full-year care

Do you currently provide or are you willing to care for children on subsidy (Employment-Related Day Care, ERDC) and children with special needs? *

Yes

No

Mailing address (If selected to receive grant funds, the address your check will be mailed to must match the WOU Substitute W-9.)

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Physical address (if different)

Street Address

Address Line 2

City

State

Zip Code

Preferred method of contact *

Phone

Text

Email

How long have you been providing child care at your current location? *

How many children does your program currently care for? *

How many employees does your program currently have? *

Does the State of Oregon license you to provide child care? *

Yes; If yes, what's your license number

No, but I am willing to become licensed as a requirement of this grant opportunity

License number *

Do you or the program own the property where your program is located (not leased or rented)? *

Yes

No

What languages do you speak with the children and families in your program? (Check all that apply) *

Tell us about your project?

What would happen in your program if your project was funded and completed? (Check all that apply) *

Become licensed and serve more children

Increase licensed capacity and serve more children

Provide a safer, or more appropriate, indoor and/or outdoor environment for children

What type of facility improvement project are you considering (Projects that are not construction or major/minor renovation will not be accepted)? *

Construction

Major Renovation

Minor Renovation

Not facility improvement

Please describe your project and what you would like to do.

What is the project?
How will you accomplish the project?
How is your project different from other projects?
How will your project help you:

become licensed and serve more children?
increase licensed capacity and serve more children?
provide a safer or more appropriate, indoor and/or outdoor environment for children?

*

Do you have a relationship with staff from the field of early care and education to support you in your project development? *

I verify that the information submitted is accurate to the best of my knowledge. I understand that information submitted in the application may be verified and discussed with local CCR&R, Hub, Inclusive Partners staff, or Office of Child Care Licensing Specialists. *

clear

First Name *

Last Name *

Date * +