Early Child Care Business Accelerator Program for Central Oregon Home-Based Providers

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

City

Must be located in Deschutes, Jefferson, or Crook counties or Confederated Tribes of Warm Springs

Zip Code

Preferred Language

Age

Ethnicity

Race

Gender

Sex

Where did you hear about this program?

Are you currently a child care provider?

If you are a licensed provider, how long have you been licensed?

What type of program are you interested in opening?

Click here to access information about Licensed Family Child Care Home types.

Do you know the Child Care Licensing Division requirements for becoming a licensed provider?

Do you provide or will you provide a dual language program?

What term do you intend to register for?

Have you completed or are you in the process of completing the following? Check all that apply.

Please upload the documents you have already obtained below.

Central Background Registry Confirmation *must be submitted before start of term*

Lead Test Results *must be submitted before start of term*

Certificate of Introduction of Registered Family Child Care Part 1

Do you have any questions?