Sparkler Program Partner Form

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The Department of Children and Youth and Bright Beginnings are excited to offer your program access to Ohio's ASQ Online service. To become a program partner and build your Sparkler dashboard, please sign the Sparkler Learning Sponsoring Partner Personal Information Protection Policy and complete the form below. You will then receive an email with directions on how to create a Sparkler Dashboard account for your program. (Note: Please allow 5 business days.) Note that only one partner form is needed per program. The administrator you list below will have the ability to create users within the account. If you need assistance, please contact asq@helpmegrow.org

In Sparkler, parents consent to sharing their data with "Sponsoring Partners." What is the name of your organization and/or your umbrella organization that families will be sharing their information with? (For example, this could be the name of your program, school district or medical practice) *

Program Type *

Early Care and Education (Center based)

Early Care and Education (School district)

Early Care and Education (Family childcare home)

Medical

Home Visiting

Early Intervention

Parent Support

Do you have multiple site locations? If yes, please submit a new form for each site/building. *

Yes

Address of Your Headquarters/School/Center (Street Address, City, ZIP, State). We will hand deliver your Startup Kit to this address in 3-4 weeks. *

Program County *

Program email address *

Program Phone Number *

Sparkler Account Administrator's Name *

Sparkler Account Administrator's Title *

Sparkler Account Administrator's professional email address. This will be the email address used to create your user account and send all communications. *

Program SUTQ Rating (if applicable)

Not rated

Bronze

Silver

Gold

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Approximately how many children birth through age 5 do you expect to serve within the next year? *

Please sign the required Sparkler Learning Sponsoring Partner Personal Information Protection Policy? *

My organization has signed and submitted the form

My organization has NOT signed and submitted the form yet. Please do not submit this form until you have signed the Information Protection Policy.

Please share any questions or thoughts you have! If you have urgent questions, email asq@helpmegrow.org

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