Adapt to Impact - Get Started!
Thank you for your interest in Adapt to Impact! This project promotes inclusive learning environments in childcare programs throughout Colorado. Complete this form if you are a licensed childcare provider in a home, school, or community setting in Colorado and are interested in being better prepared to support children with delays and disabilities in your childcare program by:
  • borrowing adaptive toys, materials and equipment from our loan library
  • accessing instructional videos
  • completing free online training for credit
  • receiving resources and support
After submitting this form, you will receive an email outlining your next steps. Please contact us at AdaptCIDE@ucdenver.edu if you have any questions. Learn more about Adapt to Impact by visiting our website.
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Childcare program name: *
Your first name:  *
Your last name: *
Your role or position: *
(e.g., Owner, Director, Lead Teacher, Direct Childcare Provider, Administrator)
Your email address: *
Phone number: *
Colorado childcare program license number: *
(If you are unsure, you can look it up on the Colorado Shines website.)
Program street address: *
Address line 2 (if applicable):
City:  *
State: *
Zip code: *
County:  *
Early Childhood Council:  *
If you don't know your childhood council, you can look it up on this Colorado ECC Map.
Program director name and email address (if different than previous question):
Alternate contact name: 
 *
Please provide an alternate contact if we’re not able to reach you.
Alternate contact role:  *
Please provide an alternate contact if we’re not able to reach you.
Alternate contact email: *
Please provide an alternate contact if we’re not able to reach you.
Alternate contact phone number:  *
Please provide an alternate contact if we’re not able to reach you.
Would you like to include additional staff members in Adapt to Impact? If so, please list their first and last name and email address.
QRIS/Colorado Shines rating: *
(If you are unsure, you can look it up on the Colorado Shines website.)
Type of child care setting: *
What age are the children you serve in your program (excluding ages 6+)? 
 *

Do any of the children in your program receive specialized services in an area of development (i.e., speech therapy, physical therapy, etc.) on a formal service plan (including IFSP or IEP)? 

 *
Does your program accept Colorado Child Care Assistance Program (CCCAP)? 
 *
Does your program participate in Colorado’s Universal Pre-K Program (UPK)? 
 *

Total number of children in your program:

 *

Number of children under age 3 in your program:

 *

Number of children ages 3-5 in your program:

 *

Please select the underserved populations you are currently serving in your program:

 *
(Select all that apply)
Required
Why are you interested in participating in Adapt to Impact? 
 *

How did you hear about Adapt to Impact?

 *
If you were referred by a friend or colleague, please write their name in "Other."
Required

Is there anything else you want us to know about your program or the children you serve?

Please select the courier location below that is closest to you in case we need to send items to you through the public library interlibrary loan system. If none of these are close to you, or you are not sure, select the final option and someone will reach out to assist you.  *
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