• Name of Nominee

• Address

• City

• Zip

• Telephone Number

• Your Name

• Your Address

• Your City

• Your Zip

• Your Telephone Number

• How long has your child(ren) been in the care of this provider?

• 1) Membership
  Please check all that apply to the best of your knowledge…or ask your provider.
  Is your provider a member of any of the following organizations?
  Dakota County Family Child Care Association (DCFCCA)
  Minnesota Licensed Family Child Care Association (MLFCCA)
  National Association of Family Child Care (NAFCC)
• Other (please specify)

• 2) Education
  Child Development Associate (CDA)
  NAFCC Accreditation
  Certificate in Child Development
  Diploma in Child Development
• Degree in Child Development. If so, what degree(s)?
• Other related degree

• 3) How Does Your Provider Communicate with You? (check all that apply)
  E-mail
  Daily Notes
  Bulletin Board
  Newsletter
  Journals
  Daily / Verbal
  Conferences
  Photos
  Phone
  Monthly Calendar
• Other (please list)

• 4) Does your child care provider EXCEED the 8 hours of required training each year? YesNo

For questions 5 and 6 below, no attachments will be accepted. Please be SPECIFIC in explaining the ways in which your provider is outstanding.  For judging purposes, please do NOT refer to your provider by his/her name when answering the questions.

• 5) How has your childcare provider gone "above and beyond" for your family in 2010?
  

• 6) Why do you feel your provider should be recognized as one of the 2011 "Outstanding Providers of the Year?"
  

• 7) If you would like to be contacted regarding this application, please leave a phone number where you can be reached.