Child Building Capacity Application Form Provider InformationProvider Photo *Choose FileNo file chosenDelete uploaded fileFirst Name *Middle NameLast Name *Phone *Email Address *Street Address *Apartment, suite, etcCity *State/Province *ZIP / Postal Code *Country *AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweAre you interested in opening or expanding a childcare program? *Please selectExpand an Existing ProgramOpen a New ProgramAre you working with any other organization?MICRO Enterprise Services of Oregon(MESO)Neighborhood HouseNot Currently working with another OrganizationOtherDo you have a current Childcare Background Registry number with DELC? *Please selectYesNoCentral Background Check Number (CBR Number) *Please put N/A if you currently do not have a CBR number. A CBR number is required to participate in our grants and pathwaysCBR approval letterChoose FileNo file chosenDelete uploaded fileAre you a current provider *Please selectYes, I am currently a ProviderNo, I am not currently a ProviderTell us how you work in the Early Childhood Education FieldName of Childcare or Organization you work forWebsiteStreet AddressStreet Address Line 2CityState/ProvinceZIP / Postal CodeWhat is the current step in the Oregon Registry Online (ORO)Please upload your professional development statement from your Oregon Registry Online (ORO)Choose FileNo file chosenDelete uploaded file Program Type Which license type would you like to become or expand? *Please selectRegistered Family Licensed Provider (RF) for up to 10 childrenCertified Family (CF) Licensed Provider (RF) for up to 16 childrenCertified Center (CC) Licensed ProviderHow many children are you currently licensed for? *Please select04567891011121314151620-40How many slots would you like to add to your program? *Are you participating in Oregon's Quality Improvement Rating System, SPARK? *Please selectI have never heard of SPARKI have heard of SPARK but never participated in itCQ33 Star4 Star5 StarDoes your organization/business have (or is it willing to commit to) a labor peace agreement if funded for this project? *Please selectWe do not have an agreement but willing to commitWe currently have an agreementWhat populations of children will your project serve? Check all that apply. *Black Indigenous and all children of families of colorChildren and families who speak languages other than EnglishChildren with developmental delays or disabilitiesInfants and ToddlersWhat programs are you interested in adding to your program that allows children from financially disadvantaged homes the opportunity to enroll? *Employment Related Daycare Cost (ERDC)Preschool Promise (PSP)Preschool For All (PFA)Baby PromiseInclusive PartnersNone Program Photos ClassroomDrag and Drop (or) Choose FilesBathroomDrag and Drop (or) Choose FilesDoes the property have access to an outdoor area that can be used for the playgroundPlease selectYesNoPlease share two photos of the space available for the playground.PlaygroundDrag and Drop (or) Choose Files Program Specifics What type of housing will you be opening your program in? *Please selectApartment Complex (4-5 Units)Duplex, Triplex, Fourplex ( Two-Four Connected Units)TownhomeResidential HomeOtherIs your current or planned site, zoned to allow child care? *Please selectYesNoDo you own or rent? *Please selectOWNRENTIf you rent, do you have an agreement that allows you to operate a child care business on the property?Please selectYesNoDo you currently or plan to provide care in any language other than English?Does your business/organization qualify as a Minority-Owned, Women-Owned, and/or Emerging Small Business (MWESB)? *Please selectYesNoMore specifically, which of the following do you qualify for? Check all that apply. *Minority OwnedWomen OwnedNoneOverall, how do you (if you're a single provider) or the majority of your staff identify? *Arab/Middle Eastern/North AfricanBlack/ African AmericanWhite/ European AmericanAfrican/CaribbeanLatina/South AmericanWhat lived experience and other identities do you and/or your staff members represent? Check all that apply. *Speakers of English as a Second Language (ESL)/Immigrants and RefugeesLived Experience of Poverty/Hunger/HouselessnessMale working in ECENoneWhat areas do you need support in *Classroom Set upProfessional development/trainingBusiness coachingSupport through licensing processHelp applying for SPARK and completing all supporting materialsSupport for securing your locationProgram policy and procedures developmentBudgetingRecruitment and enrollment of childrenRecruitment of staffWhat are you requesting funding for *Start up RentStart up WagesRemodeling to use space for childcareClassroom furnitureClassroom MaterialOutdoor play equipment, play structures, fences, or fall surfaceOutdoor play materialLicensing, permits, insurance other operational feesChildcare management softwareInclusionary SupportsCurriculumWhy do you want to open or expand your childcare program?What barriers to operating or expanding your childcare program have you faced?Do you currently use or plan to use an Oregon-approved curriculum in your program?Please selectYesNoN/AWhich curriculum are you using or plan to use?Do you have questions for us?Submit
