Infant-Toddler Childcare Startup Home-Based Provider Application

Application Instructions:

To submit your application, please fill out completely and send to info@leelanauearlychildhood.org. Please make sure to attach your work history document, references, and photo of the room or rooms you plan to use for childcare.

Contact Mary Ann at ________ or (231) 590-4853) with any questions regarding this application.
—We are here to help you!

1. CONTACT INFORMATION

First Name

Last Name

County

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

2. APPLICANT INFORMATION:

B. Describe your experience with children under 5 years of age.

Describe your experience with children under 5 years of age.

What is your work history? In a separate document, describe the three most recent positions that you have held, including your job title, organization, dates of employment, job description, and supervisor’s name and contact information. Attach: Work History

FileField; MaxSize=100KB; Multiple; addText=Upload_Work_History

What languages do you speak?

What is your educational background?

Provide two personal references. Attach: list of references and contact information.

FileField; MaxSize=100KB; Multiple; addText=Upload_Personal_References

3. PROPERTY & BUSINESS INFORMATION This information will help our team better understand your childcare environment. Your answers do not necessarily impact your ability to qualify for funding, your answers provide the ITCS team a better idea of what kind of start-up assistance you may need to begin your business. Do you own or rent your home?

Do other adults live in the home with you?

Is your home current on taxes and home insurance? If not, please explain.

What year was your home built?

What is the total square footage of your home?

List the room(s) you are planning to use for childcare and estimate the square footage of each room.

Attach photos of room(s)

FileField; MaxSize=100KB; Multiple; addText=Upload_Photos

How many levels is your home (excluding basement)?

Do you have a basement you are planning on using for childcare?

Do you have a garage that you are planning on using for childcare?

Does the property have a fenced yard?

To the best of your knowledge, will the property require any renovations to operate as a childcare facility? If yes, please describe below. If you’re not sure, that is okay, please provide any detail that you can and/or write “not sure”.

We are hoping to provide child care for families who work second/third shifts and weekend shifts in our community. Would you be willing to consider operating during those hours? If not, why not?

4. AUTHORIZATION AND RELEASE: I understand that by submitting this application form, I am authorizing the Leelanau Early Childhood Development Commission to evaluate my eligibility for admission into the Infant-Toddler Childcare Startup. Please let know if you have anything more to add.

How did you learn about the program?

News

Word of Mouth

Facebook

Poster

Other