Child Care Partnership Intake Form

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Child Care programs in Kearney, NE that are interested in partnering with Sixpence CCP through Kearney Public schools are asked to fill out this form. Sixpence coordinator or coaches will reach out to you for follow up. This is just a form indicating you are interested in leaning more and potentially partnering with Sixpence CCP.

Program Name *

Program Phone Number *

Program Address *

Type of Program *

Center

Family I

Family II

Director's Name *

Director's email address *

Approximately how many children 0-3 does your program serve? *

How many 0-3 classrooms do you have in your building(s)? *

Do you Accept Child Care Subsidy? *

Yes

Do you participate in the Food Program? *

Yes

Are you currently enrolled in Step Up to Quality? *

Yes

If yes, what is your current Step Rating? *

Please list any coaching initiatives your program participates in along with the coach that is providing support (Ex: Rooted, SU2Q, etc.) *

Please list any additional administrative staff and lead teachers in your 0-3 classrooms: *

What would you say your staff retention is? *

High - Your program has multiple staff that has been there for more than 5 years.

Medium - Your program has multiple staff that has been there for 1-5 years.

Low - Your program has multiple staff that has been there for less than a year.

What do you feel are the strengths of your program? *

What are some of your program's goals or areas where you would like to prioritize support? *

List some ways that you think the Sixpence/KPS partnership can help support your program? *

Anything else you would like to share about your program and goals? *

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