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#:

Annual Report, Page 5 of 24

Section 2: LICENSING/REGULATION Continued

Reporting on Licensing/Regulatory Status

NAEYC-Accredited programs and programs that have submitted an Application (Step 2) for NAEYC Accreditation are required to update NAEYC of critical incidents, suspension or revocation of license or regulatory status, and major changes according to the following timeframes. To meet upcoming Candidacy and site visit requirements for NAEYC Accreditation, a program must maintain good standing in its licensing or regulatory status by having no serious issues of noncompliance within the last year or since its last inspection.

NOTIFY WITHIN 72 HOURS	REPORT WITHIN 30 DAYS
Program staff must submit the 72- Hour Notification form if the program	Program staff must inform NAEYC of all major programmatic changes
experiences any of the following critical incidents that may impact	using the Self Report form.
program quality status:
Any suspension or revocation in program’s license or	Examples of major changes include, but are not limited to:
regulatory status
Any incident that did or could have compromised the	• Change in ownership or vendor
	• New designated program administrator
essential health or safety of any child, such as but not limited	• Change of location
to:	• Change to the physical facility or ground (due to damage,
• The death of any child from any cause	renovations, etc.)
• A critical injury to any child that results in the child being	• Incorporation of a new age category that was not
admitted to a hospital Emergency Room for treatment	previously served
(whether transported by the Emergency Medical	• Court order or legal action
Response team, program, parent, or other individual)	• Change in general program information
• Any unusual incident involving a lack of supervision	• Change in the primary or secondary contact for the
(such as but not limited to a child being left unattended or	program or related contact information
leaving the facility alone)	• Merge with an existing program
• Any suspected physical or psychological abuse of a child
at the program or by an individual that the child met
through the program.

List the date(s) in which your program submitted all applicable 72-Hour Notification and/or Self Reports to NAEYC within the past 12 months. If your program has experienced any of the incidents or changes noted above, appropriate notification must be submitted immediately.

72-Hour Notification Form(s) Submitted	Dates of Self Report Form(s) Submitted
Dates Submitted:	Dates Submitted:
N/A - My program has not submitted any 72-Hour Notification	N/A - My program has not submitted any Self Report forms in
forms in the past 12 months.	the past 12 months.

Required Criteria

Program staff must submit the 72-Hour Notification form if the program is not meeting any of the following Required Criteria listed below.

1.B.09: No use of physical punishment or other forms of physical or psychological abuse or coercion.

3.C.02: Teaching staff supervise infants and toddlers/twos by sight and sound at all times.

3.C.04: Teaching staff supervise children primarily by sight. Supervision for short intervals by sound is permissible, as long as the teachers check frequently on children who are out of sight (e.g., those who can use the toilet independently, who are in a library area, or who are napping; preschool and kindergartners).

5.A.03: At least one staff member who has a certificate showing satisfactory completion of pediatric first-aid training, including managing a blocked airway and providing rescue breathing for infants and children, is always present with each group of children. When the program includes swimming and wading and when a child in the group has a special health condition that might require CPR, one staff person who has successfully completed training in CPR is present in the program at all times.

5.A.12: Infants placed to sleep on their backs unless otherwise ordered by a physician.

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

Program ID#:

Annual Report, Page 6 of 24

Section 3: PROGRAM SCHEDULE

Program Closures

Indicate the dates your program will be closed for the next 12 months. Begin with the current month and place an X over the dates in each month in which your program will be closed.

Month	Dates Closed																														Year
	1		2				3				4				5		6		7		8		9	10	11	12	13	14	15	16
																															20
Select the current month	17		18				19				20				21		22		23		24		25	26	27	28	29	30	31
		Check if program is closed for the entire month
	1		2				3				4				5		6		7		8		9	10	11	12	13	14	15	16
																															20
	17		18				19				20				21		22		23		24		25	26	27	28	29	30	31
		Check if program is closed for the entire month
	1		2					3				4			5		6		7		8		9	10	11	12	13	14	15	16
																															20
	17		18					19				20			21		22		23		24		25	26	27	28	29	30	31
		Check if program is closed for the entire month
	1		2					3				4			5			6		7	8		9	10	11	12	13	14	15	16
																															20
	17		18					19				20			21			22		23	24		25	26	27	28	29	30	31
		Check if program is closed for the entire month
	1		2					3				4			5		6			7	8		9	10	11	12	13	14	15	16
																															20
	17		18					19				20			21		22			23	24		25	26	27	28	29	30	31
		Check if program is closed for the entire month
	1			2				3				4			5		6		7		8		9	10	11	12	13	14	15	16
																															20
	17			18				19				20			21		22		23		24		25	26	27	28	29	30	31
		Check if program is closed for the entire month
	1			2					3				4		5		6			7	8		9	10	11	12	13	14	15	16
																															20
	17			18					19				20		21		22			23	24		25	26	27	28	29	30	31
		Check if program is closed for the entire month
	1				2					3				4		5		6		7	8		9	10	11	12	13	14	15	16
																															20
	17				18					19				20		21		22		23	24		25	26	27	28	29	30	31
		Check if program is closed for the entire month
	1				2					3				4		5		6		7	8		9	10	11	12	13	14	15	16
																															20
	17				18					19				20		21		22		23	24		25	26	27	28	29	30	31
		Check if program is closed for the entire month
	1					2				3				4		5		6		7	8		9	10	11	12	13	14	15	16
																															20
	17					18				19				20		21		22		23	24		25	26	27	28	29	30	31
		Check if program is closed for the entire month
	1					2				3				4		5		6		7	8		9	10	11	12	13	14	15	16
																															20
	17					18				19				20		21		22		23	24		25	26	27	28	29	30	31
		Check if program is closed for the entire month
	1					2				3				4		5		6		7	8		9	10	11	12	13	14	15	16
																															20
	17					18				19				20		21		22		23	24		25	26	27	28	29	30	31
		Check if program is closed for the entire month

Note that NAEYC will not conduct site visits on Federal Holidays, including New Year’s Day, Birthday of Martin Luther King, Jr., Washington’s Birthday, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving Day, and Christmas Day. For more information on Federal Holidays, refer to the U.S. Office of Personnel Management.

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

Program ID#:

Annual Report, Page 7 of 24

Section 3: PROGRAM SCHEDULE Continued

Hours of Operation

Indicate the days of the week your program operates and time of day your program opens and closes each day.

Program is open 24 hours/day, 7 days a week

Days Open

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

	Opening	:	:	:	:	:	:	:
		a.m.	a.m.	a.m.	a.m.	a.m.	a.m.	a.m.
	Time
		p.m.	p.m.	p.m.	p.m.	p.m.	p.m.	p.m.

	Closing	:	:	:	:	:	:	:
		a.m.	a.m.	a.m.	a.m.	a.m.	a.m.	a.m.
	Time
		p.m.	p.m.	p.m.	p.m.	p.m.	p.m.	p.m.

Age Categories Served

Each age category served by the program must be represented in at least one group on the day of the site visit. For example, if a program serves infants and toddler/twos, the NAEYC Assessor must have the opportunity to observe at least one group containing infants and one group containing toddlers/twos on the day of the site visit.

Complete the following chart to identify the age categories served by your program and when each age category is in session.

	NAEYC Defined Age Categories	My program	My program	My program
	(Age ranges for each of the age categories overlap			ALWAYS
		NEVER serves	SOMETIMES serves
	for program flexibility. Programs can choose the			serves this age
		this age category.	this age category.
	age category that applies to children whose ages			category.
	fall within the overlapping portion of the age
		Check ONE of the appropriate boxes for each age category:
	ranges.)
	Infant: birth - 15 months		Indicate all timeframes during which
			infants are NOT served:
	Toddler/Two: 12 - 36 months		Indicate all timeframes during which
			toddlers/twos are NOT served:
	Preschool: 30 months - 5 years		Indicate all timeframes during which
			preschoolers are NOT served:
	Kindergarten: enrolled in a public		Indicate all timeframes during which
	or private kindergarten
			kindergartners are NOT served:

NOTE: Children within all eligible groups a program serves must be reported. This includes children from groups that operate during the summer and after-school care groups.

Additional Information

Note any special circumstances regarding your program’s schedule that may affect the scheduling of a site visit.

Do not exceed the space provided.

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

Program ID#:

Annual Report, Page 8 of 24

Section 4: GROUP INFORMATION

Summary of Groups

Please report on all eligible groups your program serves. Refer to Clarification on Groups to determine how many groups your program serves and the age categories that apply to each group. Direct questions about how to report on groups within your program to 1-800-424-2460, option 3, option 1.

Age Categories

# of

# of

Total

# of

Part Day Groups

Full Day Groups

Groups

(meet for <5 hrs)

(meet for ≥5 hrs

)

Infant Group(s)

Toddler/Two Group(s)

Preschool Group(s)

Kindergarten Group(s)

Mixed Age Group(s)

TOTAL of all groups:

If yes, how much time do the children in this program typically speak a language other than English?

all of the time

most of the time

sometimes

never

Satellite Locations

Only complete this section if any of the groups are housed in a satellite location.

A program with satellite location must meet the following criteria:

1.Have no more than 2 satellite locations

2.Location is within 5 mile radius

3.The satellite location/s enroll 60 or fewer children

4.One Program Administration

5.One Budget

6.One Public Identity

Satellite Site Address 1

Street Address:

Suite/dept/floor:

City:

State:

Zip:

Satellite Site Address 2

Street Address:						Suite/dept/floor:
City:					State:	Zip:

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

Program ID#:

Annual Report, Page 9 of 24

Section 5: MEETING NAEYC STANDARDS AND CRITERIA

Topic Area 10.F. Program Evaluation, Accountability and Continuous Improvement

Please report on all four of the criteria listed below and provide comments on what your program has done in the past 12 months to continue to meet and maintain these criteria. You may refer your program’s policies, systems, and procedures found in your Program Portfolio related to routine monitoring of program performance to ensure program accountability, continuous program improvement, and enhanced outcomes for children, but you are not required to do so. For guidance related to these criteria, refer to the TORCH Criteria Search.

Criterion	Rating	Comments
10.F.02: The annual evaluation processes
include gathering evidence on all areas of program
functioning, including
a. policies and procedures;
b. program quality;
c. children's progress and learning, family	Meet
involvement and satisfaction, and community
	Do Not Meet
awareness and satisfaction.

d.A report of the annual evaluation findings is shared with families, staff, and appropriate advisory and governance boards, and the results are used as a basis for continuing successful activities and for changing those that need improvement.

10.F.03: The program establishes goals for
continuous improvement and innovation using
information from the annual program evaluation.		Meet
The program uses this information to plan
		Do Not Meet
professional development and program quality-
improvement activities as well as to improve
operations and policies.
10.F.04: The program offers staff and families
opportunities to assist in making decisions to
improve the program. Collaborative and shared		Meet
decision making is used with all participants to build
trust and enthusiasm for making program changes.		Do Not Meet
Staff and families meet at least annually to consult
on program planning and ongoing program
operations.
10.F.05: The program has an ongoing monitoring
system to ensure that all program goals and
requirements are met. The program has a data		Meet
system that is used to collect evidence that goals
		Do Not Meet
and objectives are met; this evidence is
incorporated in the annual program evaluation.
(This criterion is an Emerging Practice.)

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

Program ID#:

Annual Report, Page 10 of 24

Section 5: MEETING NAEYC STANDARDS AND CRITERIA Continued

Most Improved NAEYC Accreditation Criteria

Please report on five current NAEYC Accreditation Criteria that the program has continued to improve upon. Programs are not required to address criteria from Topic Areas that were cited as areas for improvement in the Accreditation Decision Report, but may wish to do so. Please indicate the criterion number, rating and provide a brief comment for each criterion listed.

Criterion	Rating	Comments

Meet

Do Not Meet

Meet

Do Not Meet

Meet

Do Not Meet

Meet

Do Not Meet

Meet

Do Not Meet

Most Challenging NAEYC Accreditation Criteria

Please report on five current NAEYC Accreditation Criteria that are the most challenging for the program to meet. Please indicate the criterion number, rating and provide a comment for each criterion listed.

Criterion	Rating	Comments

Meet

Do Not Meet

Meet

Do Not Meet

Meet

Do Not Meet

Meet

Do Not Meet

Meet

Do Not Meet

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

Program ID#:

Annual Report, Page 11 of 24

Section 6: DESIGNATED PROGRAM ADMINISTRATOR QUALIFICATIONS

The Designated Program Administrator is responsible for receiving written correspondence regarding the program's accreditation and can update NAEYC with changes to program information. See Clarification on Program Administrator for more information.

Name:

Select one of the following options as it best relates to the administrators qualifications.

A. Has at least a baccalaureate degree with 24 credits in ECE, CD, ElEd or EC Spec Ed AND 9 credits in administration, leadership, or management.

B. Has plan in place to meet the qualifications outlined in Option A within 5 years.

C. Meets the alternative pathway – must document a total of 100 points across all 3 categories: education, administrator experience and relevant training or credentials.

D. Does not meet the qualifications described in A, B, or C. Describe the plans if any, in place toward meeting A, B, or C listed above:

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

Program ID#:

Annual Report, Page 12 of 24

Section 7: TEACHING STAFF QUALIFICATIONS OPTION GUIDE

Use the guide below as a reference if your program has experienced staff changes to indicate the qualifications of the teaching staff members. Indicate the total number of Teachers and/or Assistant Teachers-Teacher Aides for each option as it relates to their qualifications. Be sure to choose one option per teaching staff member, using the highest level of education when reporting staff qualifications for the new age group. For example, if a teacher has a CDA Credential and is working on an Associate’s degree in ECE, then choose option E.

EXAMPLE: A program consisting of 5 Teachers and 5 Teacher Assistants-Teacher Aides with the following qualifications:

(For Teachers: 2 Baccalaureate in ECE; 1 Baccalaureate in ElEd; 1 Associate’s in EC Spec Ed; and 1 CDA)

(For Teacher Assistants-Teacher Aides: 1 Associate’s in ECE; 2 CDA’s; 2 high school)

Use the charts below to indicate the teaching staff qualifications for the new group.

Teachers Qualifications

Assistant Teachers/Aides Qualifications

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

Program ID#:

Annual Report, Page 13 of 24

Section 7: TEACHING STAFF QUALIFICATIONS AND STAFF TURNOVER

Teacher Qualifications

Total number of Teachers:

Employed MORE THAN 12 Months

How many Teachers have been employed at this program for 12 months or more?

Of these Teachers, list the total number of Teachers that meet each option below:

Teacher Qualifications

Option

A

B

C

D

E

F

G

H

I

J

K

None

Total #

How many Teachers experienced a change in assignment and/or teaching role?

Describe the change(s) and how the change(s) have impacted the program:

Employed LESS THAN 12 Months

How many Teachers have joined the program within the last 12 months?

Of these Teachers, list the total number of Teachers that meet each option below:

Teacher Qualifications

Option

A

B

C

D

E

F

G

H

I

J

K

None

Total #

Former Teacher Qualifications

How many Teachers have left the program within the last 12 months?

Of these Teachers, list the total number of Teachers that meet each option below:

Teacher Qualifications

Option

A

B

C

D

E

F

G

H

I

J

K

None

Total #

Contributions To Staff Changes

Does the mission, community context, or type of early childhood program contribute to consistent trends in changes of teaching staff, such

as a higher rate of staff turnover (e.g., lab school, migrant program, parent co-op, serving military personnel)?	Yes	No
If yes, please explain

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

Program ID#:

Annual Report, Page 14 of 24

Section 7: TEACHING STAFF QUALIFICATIONS AND STAFF TURNOVER Continued

Assistant Teacher-Teacher Aide Qualifications

Total number of Assistant Teacher-Teacher Aides:

Employed MORE THAN 12 Months

How many Assistant Teachers-Teacher Aides have been employed at this program for 12 months or more?

Of these Assistant Teachers-Teacher Aides, list the total number Assistant Teachers-Teacher Aides that meet each option below:

Teacher Assistant-Teacher Aide Qualifications (refer to page 12 for option descriptions)

Option

A

B

C

D

E

F

G

H

I

J

K

None

Total #

How many Assistant Teachers-Teacher Aides experienced a change in assignment and/or teaching role? Describe the change(s) and how the change(s) have impacted the program:

Employed LESS THAN 12 Months

How many Assistant Teachers-Teacher Aides have joined the program within the last 12 months?

Of these Assistant Teachers-Teacher Aides, list the total number Assistant Teachers-Teacher Aides that meet each option below:

Teacher Assistants/Aides Qualifications (refer to page 17 for option descriptions)

Option

A

B

C

D

E

F

G

H

I

J

K

None

Total #

Former Assistant Teacher-Teacher Aide Qualifications

How many Assistant Teacher /Aides have left the program within the last 12 months?

Of these Assistant Teachers-Teacher Aides, list the total number Teacher Assistants-Teacher Aides that meet each option below:

Teacher Assistants/Aides Qualifications (refer to page 17 for option descriptions)

Option

A

B

C

D

E

F

G

H

I

J

K

None

Total #

Description Of Staff Changes

		.,
Does the mission, community context, or type of early childhood program contribute to consistent trends in changes of teaching staff (e.g.
lab school, migrant program, parent co-op, serving military personnel)?	Yes	No
If yes, please explain:

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Program ID#: