Birmingham Talks Partnership Application
Use this form to tell us more about your childcare center and why you're interested in partnering with Birmingham Talks! For any additional questions, please contact us: Thank you for your interest!

Sign in to Google to save your progress. Learn more
Name *
Title *
Email *
Phone number *
Name of center: *
Address of center: *
Does your center accept Childcare Central payments?
Clear selection
What percentage of the children who attend your center receive government assistance? *
This includes Medicaid and/or Childcare Central subsidies.
How many children 4 and younger are currently regularly attending your center? *
How many teachers currently work with children 4 and younger? *
In order for Birmingham Talks to be able to partner with your center, each teacher must be able to participate in a 30 minute coaching session weekly for 9 weeks. This could occur before children arrive, after children leave, during a break, during planning time, when classes are combined, or when children are napping. This cannot occur while teachers are actively supervising children who are awake. Does your center have the ability to allow teachers this time to participate in coaching? *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Small Magic. Report Abuse