First Name

Last Name

Email

Program Name

License Number

Child Care License Type

Address

County

Accreditation Program Eligibility You are at least 21 years of age with a high school diploma or GEDYou hold an operational license as a FCCHI or FCCHII and are in compliance with Nebraska Child Care Services licensing regulationsYou are providing care for at least three children with at least one living outside of your homeYou have at least 12 months experience operating as a licensed family child care provider

Please confirm that you can meet all of the background check eligibility requirements of the Accreditation Program You and your staff/subs have completed (or can obtain) fingerprinting for state background checks and can provide a letter of passing fingerprints checks with the accreditation applicationAll program staff and volunteers are in compliance with all licensing requirements regarding current background checks

Please confirm that you can meet all of the health and wellness eligibility requirements of the Accreditation Program You and any staff/subs will obtain a current CPR and First Aid certification at the time of the accreditation application submissionYou and any staff/subs will have a Health Information Report completed and dated within two years of the accreditation application submissionYou and any staff/subs will have a TB screening completed and dated within two years of the accreditation application submission

Please confirm that you can meet all of the participation eligibility requirements of the Accreditation Program You will become a member of the National Association of Family Child Care at the cost of 45.00 for a year membershipYou will commit to participate in the scheduled monthly Accreditation Toolkit Community of Practice meetings and monthly mentorship sessions that focus on successful application completion for at least 18 monthsYou will create a quality improvement plan with your mentor based on NAFCC Quality StandardsYou will create a professional development plan with your mentor based on professional growth requirements and accreditation training requirements

Why do you want to become accredited?

What impact are you hoping accreditation will have on your child care program?

List all of the early childhood initiatives and activities you are currently involved in, including any child care support groups.

How many hours of professional development have you obtained from January 2022 - present date?

Please indicate your Step Up to Quality Rating

Do you accept Child Care Subsidy?