Naeyc Report Form – Fill Out and Use This PDF

NAEYC First through Third Anniversary

Annual Report

NAEYC no longer accepts the Annual Report up to two (2) calendar months past a program’s accreditation anniversary date. The Annual Report will be accepted up to two (2) calendar months before the accreditation anniversary date, but the postmark date of the Annual Report submission must be on or before the accreditation anniversary date. A program that needs additional time is permitted to submit the Annual Report up to one (1) calendar month after its anniversary date if it pays a late fee of $150.

The following graphic further explains the Annual Report Submission Window that all programs must follow at this time.

© 2015. National Association for the Education of Young Children. All rights reserved.

NAEYC First through Third Anniversary

Annual Report

PURPOSE

The purpose of the Annual Report is to:

•Ensure that accredited programs are continuing to meet the NAEYC Early Childhood Program Standards and Accreditation Criteria.

•Increase the accountability of the NAEYC Accreditation system for children, families, and all customers of NAEYC Accreditation.

•Provide NAEYC with the most up-to-date information related to the program’s current daily operations and overall characteristics.

INSTRUCTIONS

The Annual Report is due on the first, second, third, and fourth anniversary of a program’s accreditation (refer to the program’s accreditation certificate for this anniversary date). Failure to submit an Annual Report within the established submission window will result in the revocation of the program’s accreditation. In order to complete this report programs will need to refer to the criteria, which are available on The Online Resource Center Headquarters (TORCH) to support program quality improvement, in the publication NAEYC Early Childhood Program Standards and Accreditation Criteria (NAEYC # 9900), and in the NAEYC Self-Study

Kit.

TABLE OF CONTENTS

Section 1: Program Information (Pages 2-3)

Section 2: Licensing/Regulation (Pages 4-5)

Section 3: Program Schedule (Pages 6-7)

Section 4: Group Information (Pages 8)

Section 5: Meeting the NAEYC Standards and Criteria (Pages 9-10)

Section 6: Designated Program Administrator Qualifications (Pages 11)

Section 7: Teaching Staff Qualifications (Pages 12-15)

Section 8: Rights and Responsibilities (Pages 16)

Section 9: Fees for NAEYC Accreditation (Pages 17)

Section 10: Payment Information (Pages 18)

Section 11: Submission Instructions (Pages 19)

Section 12: Research Participation (Pages 20-24)

© 2015. National Association for the Education of Young Children. All rights reserved.

Program ID#:

Annual Report, Page 2 of 24

Section 1: PROGRAM INFORMATION

Program Identification

Program Name:

Legal name to appear on all correspondence and official documents from NAEYC, including the NAEYC Accreditation Certificate.

Program ID#:

	Designated Program Administrator			Secondary Contact
	The Designated Program Administrator is responsible for receiving			The Secondary Contact will be copied on all correspondence regarding
	written correspondence regarding the program's accreditation and can
				the program's accreditation and can update NAEYC with changes to
	update NAEYC with changes to program information. See Clarification on
				program information.
	Program Administrator for more information.
	Name:			Name:
	Title:			Title:
	Phone:		Fax:	Phone:	Fax:
	Email:			Email:

Additional Contacts

Additional Contacts are authorized to receive confidential programmatic information from NAEYC. Programs may name up to three (3) additional contacts.

Multiple Programs within the Same Facility

NAEYC Accreditation is granted to the overall program, and will not be granted to individual classrooms within a program. Throughout the NAEYC Accreditation process, all eligible groups a program serves must be reported and may be observed during a site visit. This includes groups within

the program that operate during the summer and after-school care groups.

Agroup can only be excluded from a program’s NAEYC Accreditation if it is part of a separate program that has a separate public identity. A program pursuing NAEYC Accreditation must notify NAEYC of all separate programs that operate within its facility and be able to demonstrate a separate budget, administration, license and/or other criteria.

Complete the information below to inform NAEYC of other programs that operate within your program’s facility.

NOTE: If “yes” is checked above, and your program offers a summer camp option or after-school care groups, these groups must be reported and may be observed during a site visit.

If yes, use the space below to list other programs that operate within your program’s facility and describe how other existing programs are separate from your program. Include relevant information about how all other existing programs have a separate name, budget, administration, and/or license from your program.

If necessary, you may attach an additional page to continue your description of separate programs that operate within your program’s facility.

Security Clearance

Is a security clearance required upon entry to the program?

If yes, a security clearance must be given prior to an announced or unannounced site visit, please provide the name and phone number for the proper authority outside of your program.

Name:	Email:
Relationship to program:	Phone:

© 2015. National Association for the Education of Young Children. All rights reserved.

Program ID#:

Annual Report, Page 3 of 24

Section 1: PROGRAM INFORMATION Continued

Program Address

Contact information will be posted on the NAEYC website when a program achieves NAEYC Accreditation.

Street Address: Suite/dept/floor:

City:

State:

Zip:

County:

Country:

Phone:

Fax:

Website

:

Email:

Mailing Address

To be used for written correspondence to the program.

Same as program address

Street Address:		Suite/dept/floor:
City:	State:	Zip:
County:	Country:
Email:	Phone:

Billing Address

To be used for invoices sent to the program.

Same as program address

Same as mailing address

Attention:

This individual must also be listed as the Designated Program Administrator, Secondary Contact, or an Additional Contact on page 1.

Organization Name (if different than program name):

Street Address:		Suite/dept/floor:
City:	State:	Zip:
County:	Country:
Email:	Phone:	Fax:

Shipping Address

To be used for the shipment of all NAEYC Accreditation Materials.

Same as program address	Same as mailing address	Same as billing address
Street Address:			Suite/dept/floor:
No P.O. Boxes accepted
City:		State:	Zip:
County:		Country:
Email:		Phone:

© 2015. National Association for the Education of Young Children. All rights reserved.

Program ID#:

Annual Report, Page 4 of 24

Section 2: LICENSING/REGULATION

Licensing/Regulatory Status (Includes programs that are license exempt)

Programs must be regulated by the appropriate licensing/regulatory body or in process of obtaining a license in order to become an Applicant for NAEYC Accreditation. Define the licensing/regulation status based on the four options below.

Option 1: My program is licensed.

Appropriate licensing bodies refer to state licensing agencies.

My program is licensed by: State:	Agency:	with a:	Full License
			Temporary License
			Provisional License
			Other:

My program is license-exempt, but voluntarily licensed.				No	Yes
My program’s license expires.	No	Yes – if yes, indicate expiration date:
License Number:			Specialist Name:			Phone:
					OR

Option 2: My program is regulated.

Appropriate regulatory bodies refer to public agencies such as a board of education or the military.

My program is regulated by:

My program’s regulation expires. No Yes – if yes, indicate expiration date:

OR

Option 3: My program is license-exempt, eligible for licensure, and began the application process to become licensed.

The application process for licensure was begun in: Month:		Year:
With: State:	Agency:

Until the program becomes licensed, I verify that:

1)The program administrator has reviewed the state’s licensing requirements;

2)The Board chair/president or owner has reviewed the state’s licensing requirements;

3)My program is voluntarily in compliance with the state’s licensing requirements; and

4)Upon registration of children in the program, my program provides families with a copy of the state’s licensing requirements, informs families that the program is license-exempt, and informs families that the program is voluntarily in compliance with the state’s licensing requirements.

OR

Option 4: My program is license-exempt, and legally prohibited from licensure.

Iverify that:

1)The program administrator has reviewed the state’s licensing requirements;

2)The Board chair/president or owner has reviewed the state’s licensing requirements;

3)My program is voluntarily in compliance with the state’s licensing requirements;

4)Upon registration of children in the program, my program provides families with a copy of the state’s licensing requirements, informs families that the program is license-exempt, and informs families that the program is voluntarily in compliance with the state’s licensing requirements;

5)The program has documentation of fire and health inspections; and

6)The program will have completed a criminal background check on all staff and have complied with state and federal law concerning background checks. In addition, the program employs no individual convicted of a crime involving sexual abuse or child abuse or neglect.

© 2012. National Association for the Education of Young Children. All rights reserved.

Program ID#: