Naeyc Report Form PDF Details

Are you a teacher, care provider, or program administrator that needs to understand the more technical aspects of child care? The National Association for the Education of Young Children (NAEYC) offers a report form as part of its accreditation process that can help guide your way. This blog post will explore what components are necessary within the NAEYC report form and provide some helpful tips and best practices so you can complete this important document with confidence. Let’s dive in!

QuestionAnswer
Form NameNaeyc Report Form
Form Length25 pages
Fillable?No
Fillable fields0
Avg. time to fill out6 min 15 sec
Other namesnaeyc accreditation, how to naeyc report, how to through annual report, naeyc annual report

Form Preview Example

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.

Name:

Title:

Name:

Name:

Title:

Title:

 

 

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.

My program is the only program that operates within its facility.

Yes No

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.

In addition to my program, one or more programs operate within the same facility.

Yes No

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?

No

Yes – If yes, provide the name and phone number for the proper authority outside of your program below.

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

My program operates 12 months/year.

OR

My program operates less than 12 months/year.

The program begins serving children on

/

/

.

The program ends on

/

/

.

 

 

 

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:

Do any children in this program speak languages other than English?

No

Yes – The children speak:

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.

Option A.

Option B.

Option C.

Option D.

Option E.

Option F.

Option G.

Option H.

Option I.

Option J.

Option K.

(Meets Candidacy for Assistant Teachers-Teacher Aides only – Not for Teachers.) Working on the CDA Credential issued by the Council for Professional Recognition.

(Meets Candidacy for Assistant Teachers/Teacher Aides only – Not for Teachers.) Working on the NAEYC-defined equivalency of the CDA Credential issued by the Council for Professional Recognition (12 Credits in ECE, CD, ElEd, or EC Spec Ed.)

Acurrent Child Development Associate (CDA) Credential issued by the Council for Professional Recognition.

ACDA Credential equivalent as defined by NAEYC as at least 12 college credits in ECE, CD, ElEd, or EC Spec Ed.

Working on an Associate’s or higher degree in ECE, CD, ElEd, or EC Spec Ed.

An Associate’s or higher degree in ECE, CD, ElEd, or EC Spec Ed.

Working on the NAEYC-defined equivalency of an Associate’s or higher degree in ECE, CD, ElEd, or EC Spec Ed.

The equivalency to an Associate’s degree in ECE, which is defined by NAEYC as at least 60 college/university credits with at least 30 college credits in ECE, CD, ElEd, or EC Spec Ed.

The equivalency to a Baccalaureate degree in ECE degree which is defined by NAEYC as a Baccalaureate degree in any discipline with at least 36 college credits in ECE, CD, ElEd, or EC Spec Ed .

An Associate’s or higher degree in a non-ECE related field with at least 3 years experience in an NAEYC-Accredited program.

An Associate’s or higher degree in non-ECE related field with at least 3 years experience in a non-accredited program, and at least 30 contact hours of relevant training during the past 3 years.

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

Option

Total #

A

 

B

 

 

C

 

 

 

 

 

 

 

 

 

1

D

E

F

4

G

H

I

J

K

None

Assistant Teachers/Aides Qualifications

Option

Total #

A

 

B

 

C

 

 

 

 

 

 

 

2

D

E

F

1

G

H

I

J

K

None

2

© 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:

 

 

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

Program ID#:

Annual Report, Page 15 of 24

Section 7: TEACHING STAFF QUALIFICATIONS Continued

Description of Professional Development Plan

Check all relevant types of professional development for teaching staff that is supported by the program and describe the overall plan in one or two sentences.

Education programs

Training programs

Tuition reimbursement

In-service training

Mentoring

Attendance at conferences

Other

Describe Plan:

Do not exceed the space provided and do not attach additional information.

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

Program ID#:

Annual Report, Page 16 of 24

Section 8: RIGHTS AND RESPONSIBILITIES

Program Rights

Right: To receive professional and timely support from NAEYC.

Phone - (800) 424-2460, option 3, option 1. Monday - Friday, 9:00 AM to 5:00 PM ET

Email - accreditation.information@naeyc.org

Accreditation Program Support Resources

Right: To receive information from the NAEYC Academy regarding updates on the NAEYC Accreditation system, policies, and procedures.

Monthly Accreditation e-Updates emailed to primary and secondary contacts provided to NAEYC.

Bi-Annual Accreditation Updates mailed to program mailing address provided to NAEYC.

Right: To access current, accurate information about the NAEYC Accreditation process and the NAEYC Early Childhood Program Standards and Accreditation Criteria, including related assessment tools and resources.

NAEYC Academy Website

TORCH

Right: To provide feedback to the NAEYC regarding the NAEYC Accreditation process and the NAEYC Early Childhood Program Standards and Accreditation Criteria.

Submit Feedback on the Accreditation System

Submit feedback on the accreditation criteria via TORCH Criteria Feedback and TORCH Discussions

Right: To withdraw from the NAEYC Accreditation process at any time.

Program Responsibilities

Responsibility: To understand the NAEYC Accreditation process and access the most current versions of the NAEYC Early Childhood Program Standards and Accreditation Criteria and related assessment tools and resources.

For information about the NAEYC Accreditation process, visit the NAEYC Academy Website frequently and read monthly Accreditation e-Updates and bi-annual Accreditation Updates.

For current versions of the NAEYC Early Childhood Program Standards and Accreditation Criteria and related assessment tools and resources, visit TORCH.

Responsibility: To Update NAEYC of programmatic changes and critical incidents according to the appropriate timeframes.

Report major programmatic changes within 30 days using the Self Report form.

Notify NAEYC of critical incidents that may impact program quality status within 72 hours using the 72 Hour Notification form.

Inform NAEYC of updates to contact information for the primary and secondary contact of your program to ensure open communication between the program and NAEYC. Changes to contact information should be reported as soon as possible with the Self Report form.

Responsibility: To notify NAEYC immediately if Candidacy Requirements are no longer met. Failure to meet Candidacy Requirements may affect a program’s maintain status as a currently NAEYC-Accredited program.

Responsibility: To retain a copy of all forms submitted to NAEYC and retain documentation verifying the date of all submissions. Postmark documentation is acceptable for submissions by mail and a copy of sent e-mail with date and time stamp information is acceptable for e-mail submissions.

Signature

I have read and understand my program’s rights and responsibilities.

I verify that the information submitted in this form is accurate. If false or misleading information is ever provided to the NAEYC Academy, I understand that my program’s pursuit of NAEYC Accreditation will cease and/or my program’s current accreditation may be revoked.

I verify that my program continues to meet all of the eligibility requirements for NAEYC Accreditation, as reported in the Application for NAEYC Accreditation (Step 2).

______________________________________

___________________________________

Signature

Title

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

Program ID#:

Annual Report, Page 17 of 24

Section 9: FEES FOR NAEYC ACCREDITATION

NAEYC is phasing in an improved fee structure that will better assist programs in long-term budgeting for accreditation costs. Refer to your program’s Valid Until date printed on the NAEYC Accreditation Certificate to determine the fee to include along with the Annual Report. For more information, refer to www.naeyc.org/academy and click on Fees.

Valid Until Dates January 2016 and Later

$550

10

- 60 children

 

 

 

$650

61

- 120 children

 

 

$775

121 - 240 children

 

 

$885

241 - 360 children

 

 

 

Add $150 for every additional 120 children.

Note: Programs that successfully maintain accreditation over time will not pay additional renewal fees. The Annual Accreditation fee will be due annually, including on the fifth anniversary of accreditation.

The accreditation fee is calculated based on the number of children enrolled in a program at the time this form is submitted. If the number of children changes for a defined portion of the year (for example, altered program operation during the summer), the program should report the number of children that typically applies throughout the majority of the school year. Programs will be billed for supplemental fees (according to the chart above) if program enrollment is inaccurately reported during the accreditation process.

Reference the following rules to determine the number of children that determines the accreditation fee for your program.

Each child is only counted once.

Each child of eligible age (birth through kindergarten) that is part of an eligible group is counted. All eligible groups MUST be included in your program’s NAEYC Accreditation. Note that groups are not eligible if more than 50% of the children are school age (first grade and beyond).

For programs with hourly care or drop-in care groups in which the total number of children enrolled in the group exceeds the maximum licensing capacity of the group, only the maximum licensing capacity of the group is counted. Add the maximum licensing capacity of any drop-in care groups to the total number of children, if applicable.

Age Category

Number of Children Enrolled

 

 

Infant (birth to 15 months)

Toddler/Twos (12 to 36 months)

Preschool (30 months to 5 years)

Kindergarten (public or private)

TOTAL Number of Children:

This form will not be processed until NAEYC receives the applicable fee.

Late Fee

If the program submits the Annual Report up to one (1) calendar month past the accreditation anniversary due date, a late fee of $1 must be included with the payment. Please note that this form will not be accepted unless NAEYC receives the applicable fee within one (1) calendar month past the accreditation anniversary due date.

I acknowledge that this form is being submitted up to one (1) calendar month past the accreditation anniversary due date and the $150 late fee is included with the payment.

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

Program ID#:

Annual Report, Page 18 of 24

Section 10: PAYMENT INFORMATION

Choose ONE method of payment and include applicable information below.

Check

Check Number:

Name on Checking Account:

Attach check to this form

If check is sent under separate cover, program ID number or other identifying information must be included on the check.

Purchase Order

Purchase Order Number:

Name on Purchase Order:

Attach purchase order to this form.

If purchase order is sent under separate cover, program ID number or other identifying information must be included on the purchase order.

Credit Card

VISA

MasterCard

Amex

 

 

 

 

 

 

 

 

Credit Card Number:

 

 

 

 

 

 

 

 

Credit Card Expiration Date: Month:

Year:

 

 

 

 

Name on card/checking account or purchase order holder:

 

 

 

 

 

 

Card billing address:

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

State:

Zip:

 

 

 

 

 

 

Country:

 

 

 

 

 

I authorize NAEYC to charge the above credit card at the amount of $

Signature:

Programs who do not wish to provide their credit card information at this time may pay by phone, 1-800-424-2460, option 3, option1.

International ACH

International ACH Number:

Name on International ACH:

Signature:

NAEYC Information for Transfer:

Account Number: 2000013841458 Routing Number: 121000248Swift Code: WFBIUS6S

International Wire Transfer

International Wire Transfer Number:

Name on International Wire Transfer:

I acknowledge that a $20 fee is included with the payment for processing.

Signature:

NAEYC Information for Transfer:

Account Number: 2000013841458

Routing Number: 121000248

Swift Code: WFBIUS6S

 

 

 

© 2015. National Association for the Education of Young Children.

All rights reserved.

Program ID#:

Annual Report, Page 19 of 24

Section 11: SUBMISSION INSTRUCTIONS

Mail completed form with payment to:

Annual Report

P.O. Box 96037

Washington, DC 20090-6037

E-Mail completed form with payment to:

annualreport@naeyc.org

NAEYC will ONLY accept Annual Reports through e-mail if a credit card payment is included. Programs paying via check or purchase order are

not eligible to submit via -email.

Faxed Annual Reports will not be accepted.

NAEYC accepts the postmark date or the e-mail sent date as the submission date. NAEYC recommends that programs obtain written confirmation of receipt of all forms sent to NAEYC P.O. Boxes. Please discuss tracking options with your local Post Office. NAEYC is not able to sign for materials that are delivered to a P.O. Box by an individual courier such as UPS or FedEx. Similarly, NAEYC recommends that programs save a copy of any automated e-mail replies as confirmation of receipt of all forms emailed to NAEYC.

Copy this form for your program’s records before submission. NAEYC will not return this form to the program.

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

Program ID#:

Annual Report, Page 20 of 24

Section 12: RESEARCH PARTICIPATION

Information gathered on our application forms and during the site visit will become part of a national data base of early childhood knowledge. As we put together information about programs across the nation we will be able to fully describe aspects of early childhood programs in ways that have never been achieved before. Ideas that emerge from the work of programs will guide professional development, research, and program development. At no time will individual programs, teachers, children or families be identified in any way. In keeping with the professional ethics of Institutional Research Boards in universities, NAEYC is committed to keeping work of individual programs confidential.

Programs may have opportunities to engage in research projects, but will at that time be fully informed of the scope and nature of the project. If you have concerns about the use of information gathered during the accreditation process, please email qualityassurance@naeyc.org.

By providing this voluntary demographic information, your program provides data that helps NAEYC gain a better understanding of how criteria are met and whether certain criteria pose challenges for programs with various characteristics. This information is used for continuous quality improvement and guides professional development, research and program development.

Additional Program Information

This information will be used to help NAEYC better support programs in Self-Study and to evaluate the effectiveness of NAEYC Accreditation over

time. The information you provide will NOT affect your NAEYC Accreditation status in any way.

Why did your program seek NAEYC Accreditation: (check all that apply)

Required for receiving funding

Part of state Quality Rating and Improvement System (QRIS)

Prestige and recognition

Believe in NAEYC’s mission for improving quality of care for young children

Families expect it

Corporate Structure: (must choose one)

Nonprofit

Private corporation (for profit)

Public Agency:

 

school district

military

college/university

other

If the program is military, please specify the branch:

Army Navy

Air Force Marines

Coast Guard

Is your program receiving technical assistance from: (choose only one)

Accreditation Facilitation Project

State Quality Rating and Improvement System (QRIS)

Consultant

What year did your program begin operation?

What best describes your program site location? (choose only one)

Urban

Rural

Suburban

Military base

What is your program schedule? (If your program offers multiple options, choose all that apply)

Full Day (more than 6 hours/day) Part Day (up to 6 hours a day)

24hour Full Year

Part Year

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

Program ID#:

Annual Report, Page 21 of 24

Section 12: RESEARCH PARTICIPATION Continued

Additional Program Information

Do you offer any of these services? (check all that apply)

Before or after school care Drop-in care

Back up care

 

 

 

Bilingual Programs:

 

 

 

 

 

 

 

Summer camp/vacation programs

If yes what languages besides

English:

 

 

 

 

 

 

 

 

Which characteristics describe your program: (choose all that apply)

Campus-based

Migrant services

Employer-sponsored

Military

Faith-based

State Pre-Kindergarten

Parent cooperative Head Start Hospital-affiliated

Is your program located in a:

Public school (P-12)

College or university campus

US Government facility (not military) Tribal nation

Military facility

Alaskan native village

None of the above

Define your license/regulation status based on the options below:

My program is licensed/regulated:

My program is licensed.

My program is license-exempt but voluntarily licensed.

My program is regulated

(the term regulated refers to programs that are not licensed but under the regulation of, for example, public school systems, or the military. If your program is licensed and regulated by another body, please choose licensed and regulated.)

My program is not licensed but is eligible for licensure

My program is not licensed and is not eligible for licensure

Characteristics of Enrolled Children

What number of children are enrolled in your program (birth through kindergarten)?

Of the children enrolled in your program (birth through kindergarten), what number of them are:

White or Caucasian, Non-Hispanic Black or African American, Non-Hispanic Spanish/Hispanic/Latino

Asian/Pacific Islander

American Indian/Alaska Native/Native American Other: (please specify)

Of the children enrolled in your program (birth through kindergarten), what number of them speak the following languages during your program:

English:

French:

Vietnamese:

Portuguese:

Spanish:

German:

Khmer:

Other:

Chinese:

Hmong:

Italian:

 

Do any enrolled children have any of the following special needs? If so, how many?

Hearing impairment:

 

 

 

 

 

 

 

 

 

 

 

Dow

n Syndrome:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Visual impairment:

 

 

 

 

 

 

 

 

 

 

 

Emo

tional disturbance:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Orthopedic handicaps:

 

 

 

 

 

 

 

 

 

 

Autis

m, spectrum disorders:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Speech & language disorders:

 

 

 

 

 

 

Lear

ning disabilities:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Behavioral:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Maintenance care diseases (diabetes, HIV) :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Neurological disorders:

 

 

 

 

 

 

 

 

 

Mentally disabled/developmentally delayed:

 

 

 

 

 

 

 

 

 

 

 

 

 

ADHD:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other, specify:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you serve special populations?

Military families Migrant Workers

Teen parents Homeless Families

Not applicable Other, specify:

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

Program ID#:

Annual Report, Page 22 of 24

Section 12: RESEARCH PARTICIPATION Continued

Program Funding

Does your program receive any of the following types of public funding? (Check all that apply)

Child Care Subsidies

Early Head Start

Head Start

 

 

 

 

Pre-Kindergarten Funding

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Child and Adult Care Food Program

 

 

 

Other

public funds (federal, state or local)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

if yes, please specify:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For programs not operated by school districts, does your program subcontract with the school district to provide Pre-Kindergarten

services? Yes No

Does the program administrator or any member of the teaching staff receive publicly funded scholarship support for postsecondary

coursework?

Yes

 

No

Don’t know

Does the program administrator or any member of the teaching staff receive loan forgiveness from a federal Perkins, Stafford, or

Direct Loan?

Yes

No

Don’t know

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What was your program’s total income in the last fiscal year?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How much funding did you receive from the follo

wing sources:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tuition/Fees: $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In-kind c

ontributions: $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Government Grants

or Subsidies:

$

 

 

 

 

 

 

 

Private Foundation Grants: $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employers of families served: $

 

 

 

 

 

 

 

 

 

Fundrais

ing: $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Support from sponsoring organizations: $

 

 

 

 

 

Other, specify : $

 

 

 

 

 

 

 

 

 

Private donors: $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How many children enrolled (in age groups birth through kindergarten) receive need-based financial assistance to attend your program through scholarships, sliding fee scales, or public subsidies?

Characteristics of Program Administrators

How many administrators are in your program?

Of those responsible for the program’s leadership and management, how many have completed the following level of education?

Doctoral Degree

Master’s Degree

Baccalaureate Degree

Associate Degree

Some College

High School

How many of the program’s administrators have at least nine (9) credit-bearing hours of specialized college-level course work in administration, leadership, and management AND at least 24 credit bearing semester hours of specialized college-level course work in early childhood education, child development, elementary education, or early childhood special education that encompasses child development and children’s learning from birth through kindergarten; family and community relationships; the practices of observing, documenting, and assessing young children; teaching and learning processes; and professional practices and development?

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

Program ID#:

Annual Report, Page 23 of 24

Section 12: RESEARCH PARTICIPATION Continued

Characteristics of Lead Teachers

Adult with primary responsibility for a group of children.

Total number of teachers:

Of the teachers in your program, how many have completed the following highest level of education:

Doctoral Degree in ECE or related field:

Master’s Degree in ECE or related field:

Baccalaureate Degree in ECE or related field:

Associate Degree in ECE or related field:

Baccalaureate Degree in non-ECErelatedor r field:

Any Degree in non-ECE or related field:

Child Development Associate credential:

Some College:

High School/GED:

How many teachers are:

Currently enrolled in a Graduate program in ECE or related field:

Currently enrolled in a Baccalaureate program in ECE or related field:

Currently enrolled in an Associate degree program in ECE or related field:

Currently working toward a Child Development Associate Credential:

Characteristics of Assistant Teachers-Teacher Aides

Adult who works under the direct supervision of a teacher.

Total number of teacher assistants/aides:

Of the teacher assistants and teacher aides in your program, how many have completed the following highest level of education? Doctoral Degree in ECE or related field:

Master’s Degree in ECE or related field:

Baccalaureate Degree in ECE or related field:

Associate Degree in ECE or related field:

Baccalaureate Degree in non-ECErelatedor r field:

Any Degree in non-ECE or related field:

Child Development Associate credential:

Some College:

High School/GED:

How many teacher assistants and teacher aides are:

Currently enrolled in a Graduate program in ECE or related field:

Currently enrolled in a Baccalaureate program in ECE or related field:

Currently enrolled in an Associate degree program in ECE or related field:

Currently working toward a Child Development Associate Credential:

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

Program ID#:

Annual Report, Page 24 of 24

Section 12: RESEARCH PARTICIPATION Continued

NAEYC Accreditation Emerging Practice Criteria

Please report on any seven of the current 21 Emerging Practice Criteria and provide comments on the steps your program has developed and/or implemented, if any, toward meeting the Emerging Practice Criteria. A full list of Emerging Practice Criteria may be located in the TORCH Resource Library, Folder 2. The 10 Standards.

Criterion

Rating

Comments

 

 

 

Meet

Do Not Meet

Meet

Do Not Meet

Meet

Do Not Meet

Meet

Do Not Meet

Meet

Do Not Meet

Meet

Do Not Meet

Meet

Do Not Meet

Emerging Practice Criteria are identified as important aspects of program performance that are not yet widely practiced, and the early childhood field and individual programs need time to develop the capacity to meet these criteria (due to the need for additional training, major facility renovations, or an increased supply of certified consultants). Therefore, not meeting Emerging Practice Criteria does not count against a program, but credit is given when they are met.

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

Program ID#:

How to Edit Naeyc Report Form Online for Free

With the online editor for PDFs by FormsPal, you're able to fill out or change naeyc right here. Our development team is relentlessly endeavoring to develop the tool and enable it to be much faster for people with its extensive functions. Unlock an endlessly progressive experience today - check out and discover new opportunities along the way! To get the ball rolling, go through these basic steps:

Step 1: Press the orange "Get Form" button above. It'll open up our pdf editor so you could start completing your form.

Step 2: With this advanced PDF editor, you could accomplish more than simply fill out blank fields. Express yourself and make your docs look faultless with customized textual content put in, or fine-tune the file's original content to excellence - all comes along with an ability to incorporate your personal graphics and sign the document off.

Completing this form demands care for details. Ensure each field is filled in correctly.

1. While filling in the naeyc, make certain to include all of the necessary blanks in its relevant section. It will help expedite the process, allowing your information to be processed efficiently and accurately.

Guidelines on how to fill in naeyc d n get step 1

2. Once the previous part is complete, you should put in the required particulars in National Association for the, and Program ID allowing you to go further.

naeyc d n get conclusion process detailed (step 2)

3. The third stage will be straightforward - fill out all of the form fields in Prog, gram Ident, ification, r on all correspon, ndence and offici, ial documents fro, om NAEYC inclu, uding the NAEYC, C Accreditation C, Certificate, Progr, Legal, Progr, ram Name name to appear, and ram ID to finish this part.

om NAEYC inclu, Certificate, and Prog inside naeyc d n get

Lots of people frequently get some things wrong while filling in om NAEYC inclu in this area. You should go over what you enter right here.

4. It is time to begin working on this next section! In this case you've got all of these NAEY Accred the pr A grou pursui, YC Accreditation ditation process, is granted to the all eligible, overall program ps a program ser e, ther programs th, at operate within, n your programs, facility, My pr, rogram is the o, only program th, hat operates wi, thin its facility, Yes, and NOTE be obs blanks to complete.

naeyc d n get conclusion process clarified (stage 4)

5. This document has to be completed with this area. Below one can find a comprehensive set of form fields that need accurate details for your form usage to be accomplished: Relat, National, Association f, for the Educa, ation of Young, g Children A, All rights reser, rved, and Program ID.

Stage number 5 for completing naeyc d n get

Step 3: After you have reread the details you given, just click "Done" to finalize your FormsPal process. Make a 7-day free trial option at FormsPal and get instant access to naeyc - download or edit in your personal cabinet. When using FormsPal, you can complete forms without stressing about information incidents or records being shared. Our secure platform helps to ensure that your personal data is maintained safe.