Application for Services with EQuIPD (2020-2021)
You will receive an auto-confirmation email within a few minutes after submitting. Make sure to press the submit button once you are finished. If you do not have time to finish this application, you can submit the information and edit the application through the link in the auto-confirmation email. If you do not receive an email, please check your spam folder. If you did not receive the email, contact EQuIPD at
Email address *
Application for Services with EQuIPD2020-2021 **Please complete all sections** EQuIPD, c/o Gateway Research Park, Administration Building, 5900 Summit Avenue Brown Summit, NC 27214Website: Phone: 336-315-7768 Email: Our mission is to nurture and empower early care and education professionals & programs with tools to support & sustain success.
Facility Information
Name of facility *
Facility ID# *
Facility street address *
City *
Zip code *
Never submit passwords through Google Forms.
This form was created inside of UNCG. Report Abuse