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Closing / Potentially closing form
Name of Program
Name
Address
City
Zip
Phone Number
Email
License Number(s)
Are there any supports that could help you avoid closing your child care program (yes/no)
Yes
No
If yes, What supports could help you avoid closing your child care program?
Enroll More Children
Hire More Staff
Additional One Time Funding (grant, stipend, etc)
Additional On-Going Funding
Small Business Loan
If additional funding: how much funding do you need in order to sustain your current program?
If no, When do you anticipate you will be closing?
Do you own or lease your building?
Own
Lease
Are you currently fully staffed?
Yes
No
Do you currently have openings for children in your program?
Yes
No
If Yes:
Number of vacancies for 0-2
Number of vacancies for 2-5
Number of vacancies for school-age
What has been your biggest challenge of running a child care program over the last 12 months?
Submit Form
