Early Learning Coalition of Brevard County

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The Early Learning Coalition of Brevard administers multiple early learning programs including School Readiness (subsidized) child care; Voluntary Pre-Kindergarten (VPK), Child Care Resource and Referral (CCR&R), Florida First Start and Inclusion. In addition, the Coalition contracts with many child care providers, schools and pre-schools to provide quality services. The Coalition works to ensure all centers have quality learning environments and provides training and professional development for teachers.

Site last edited: 2010-09-06 11:30:02 EDT

Sponsored by the Agency for Workforce innovation. Office of Early Learning.


Is this your first time using our services?	Yes No
Full Name *
Email Address *
Gender	Male Female
Street Address *
City, State, Zip *
Home Phone *
Other Phone
Nearest Major Intersection to Where you Want your Child to Receive Care *
Intersection nearest to *	Home Work Family Member Other
'Other' intersection location


Employer
Street Address
City, State, Zip
Phone


Household *
Relationship *
Reason for Care *	Caregiver asked to leave program Caregiver no longer available Cost too high End leave of absence Employment / Working Parent / Child's Needs Unhappy with quality Relocation Training / Education Hurricane / Disaster Refuse to Answer Other
Child Care Issues	Affordability / Cost Care Ending Curriculum / Program Location / Transportation No Openings Quality Schedule Special Needs Type of Care N/A or Refuse to Share None
Referred By	Newspaper / Magazine Billboards Brochure / Poster DCF Employer / Business Children's Forum Friend / Relative Yellow Pages Office of Early Learning Licensing Radio Ad ELC School or Provider Television Web Site Word of Mouth Other


ID Number
Full Name *
Date of Birth *
Gender	Male Female
Special Needs	Yes No
School
Transportation	To From
Days Needed *	Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Time Start *
Time End *


Curriculum	No Preference A-BEKA Developmentally Appropriate Beyond Centers & Circle Time Character Based Creative Curriculum High Reach High Scope Montessori Research Based Religious Waldorf WEE Learn Other
Schedule *	24 Hour Care After School Both Full - Time & Part Time Before School Drop-In Care Emergency / Temporary Care Evening Care Full-Time Full Year Morning Open in Safe Weather Over Night Part Time Rotating Summer Only School System Weather Days School Year Vacation / Holidays Weekend Care
Special Needs	ADD / ADHD Allergies (Severe) Asthma (Severe) Autism Spectrum Disorder Behavioral Disorder (Severe) Cystic Fibrosis Developmental Delay Diabetes Hearing Imparment Mental Disbility / Delay Medically Challenged / Delayed Physical Disability / Delay Speech / Language Delay Seizure Disorder Visual Imparment Other
Environment	Air Conditioned Bi-Lingual Elevator Faith Based Center Fenced Yard Inclusionary Setting No Pool No Pets Operation Child Care Outdoor Play Pet On Site Pool On Site Sick Child Care Offered Sign Language Smoke Free Spa Teen Parent Program Wheel Chair Accessible Other
Programs *	Child Care Center Family Child Care Home Head Start Nanny / Au-Pair Play Group Non-School Based School Readiness School Age Program School Based School Readiness Summer Camp
Financial Assistance	Negotiated Rates Sliding Scale Fees Sibling Discounts Scholarship School Readiness Certificate Other Voucher
Provider Type	Licensed License Exempt Registered Sub-Contracted Gold Seal Accreditation
Transportation	From Child's Home Near Public Transportation To Child's Home Transportation Provided In Walking Distance to School
Enhanced Services	Computers Arts / Crafts Family Evnironment Field Trips Gymnastics / Dance Lessons Health / Social Services Homework Tutor Kindergarten Class Music Lessons On-Site Screenings Outdoor Sports Small Group Size Special Needs Enrolled Swim Lessons Therapeutic Services
Other Information Requested	Emergency Family Services / 211 Other Referrals Parent Education / Training Information Hurricane / Disaster
Accreditation Preference
Are you in need of assistance paying for the cost of child care?	Yes No

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