DC/Maryland Breastfeeding-Friendly Childcare Provider Recognition Awards
Nomination/Site Inspection Form 2021
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Email *
Childcare Provider Name *
Childcare Provider Address: *
Nominator (first and last name) *
Contact Person (Office Manager or Human Resource Manager) *
Contact Person E-mail Address *
Phone Number *
Type of Childcare Provider
Number of Infants, Toddlers, and Young Children Currently in Care (enter number for each age group) *
Number of teachers caring for children birth to 36 months (include all adults who care directly for these children: lead,assistant, aide, floaters, etc.)
Check all criteria that you can verify:
Practices will be recognized as follows:

Family/Home-based: Bronze Award: 6-8 points, Silver Award: 9-15 points, Gold Award: ≥ 16 points (at least 1
gold criteria must be met)
Center-based/Head Start: Bronze Award: 6-10, Silver Award: 11-18, Gold Award: ≥ 19 points (at least 2 gold
criteria must be met)
Bronze (1 Point each)
Silver (2 Points each)
Gold (3 Points each)
Please feel free to share any additional details about your breastfeeding supports.
A copy of your responses will be emailed to the address you provided.
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