Educator Provider Request for EPS Services - Region 6 FY2019 / Solicitar Servicios del Programa Region 6 FY2019
Name and Title of Person requesting EPS Services / Nombre y Título del Solicitante de los servicios EPS *
Your answer
Program Name and Address /Nombre y Dirección del Programa *
Please indicate street, city, state, and zip code at which you are requesting services
Your answer
What EPS services are you requesting? /¿Qué tipo de servicios de EPS está usted solicitando? *
Please describe how EPS can support your program improvement plan this year (June 2018-June 2019)
Your answer
What type of Program are you requesting EPS Services for? / ¿Qué tipo de los servicios de EPS está usted solicitando? *
Please check all that apply
Required
If part of a FCC System please name
Your answer
Program Number / Número del Programa *
Your program number can be found on the upper left side of your EEC license, but is a separate number from your License Number
Your answer
Program Director's Name and Phone Number / Nombre del Director y Número de Teléfono *
Please indicate the best number to reach you
Your answer
E-mail Address / Correo Electrónico *
Our primary method of communication will be via e-mail, Please be sure your email address is entered correctly.
Your answer
Confirm your e-mail address / Confirme su dirección electrónica
Your answer
Please provide your EEC Professional Qualifications Number (PQR #) / Favor de proveer el Número de Calificación Profesional (PQR #) *
For reporting purposes we need to record your PQR #
Your answer
How many children is your program licensed for? / ¿Cuántos niños tiene su programa? *
Your answer
How many educators are in your program? / ¿Cuántos educadores tiene su programa? *
Your answer
What portion of children enrolled in your program are subsidized (voucher or contract) / ¿Cuál es el porcentaje de niños matriculados en su programa que reciben subsidio (vale o contrato)? *
What language are you requesting for EPS services? / ¿En qué idioma está usted solicitando los servicios de EPS? *
Your answer
If you are participating in QRIS, what level is your program? / Si usted está participando en el QRIS. ¿En qué nivel se encuentra su programa? *
Please check which level you have been granted by EEC
What services are you and your staff interested in? / ¿En qué servicios está usted y su personal interesado? *
Please select your top 3 areas of support that you will need this year (June 2016-July 2017).
Required
Does your program have a Continuous Quality Improvement (CQI) plan or a Program Improvement plan in place? / ¿Tiene usted un plan de progreso continuo referente a la calidad de su programa (CQI)? *
The CQI plan was formerly called the Program Improvement Plan and serves as a guiding document for QRIS.
Please note any other information you think EPS staff may need to know / Favor de proporcionar cualquier otra información la cual usted cree que es necesaria para el personal de EPS
Your answer
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