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General Information
Name of Child Care Facility:
Address:
City:
Zip:
Phone Number:
Fax Number:
Email:
Director's Name:

Center Specific Information
What type of child care do you offer?	Full-day Part-day Both
Which group(s) are served?	Infant Toddler Preschool After school
Ages Served:
Hours of Operation:
Licensed Capacity:
Current Enrollment:
# Staff:
# Classrooms:
# Years in Operation:
# Members of Board of Directors:
What is the socio-economic status of the majority of the families you serve? Low-income Middle-income High-income
What percentage of children receive tuition assistance:
Are you interested in becoming accredited by NAEYC? Yes No Uncertain