Name of Nominee

Address

City

Telephone Number

Your Name

Address

City

Telephone Number
Zip Code
Zip Code
How long have you known this child care 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
Please check all that apply to the best of your knowledge...or ask your provider.
Does your provider have any of the following?
Child Development Associate (CDA)

NAFCC Accreditation

Certificate in Child Development

Diploma in Child Development
Degree in Child Development. If so, what degree?
Other related degree
3) How does your provider communicate with you?  (Check all that apply)
Email
 Phone
Daily Notes
Conferencing
Bulletin Board
Monthly
Calendar
Photos
Journals
Newsletter
Daily/Verbal
Other
4) Does your child care provider EXCEED the 8 hours of required training each year?
No
Yes
For the last two questions, please type or PRINT clearly only in the space that is
provided. 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 child care provider gone "above and beyond" for your family?  Please
give specific examples or tell us a story about your provider.
(Maximum of 10 lines please)
6)  Why do you feel your provider should be recognized as one of the "Outstanding
Provider's of the Year?"  Please give specific examples or tell us a story.
(Maximum of 28 lines please)
Your provider will receive a copy of this nomination form.

All forms must be received by January 31st, 2009 to be considered for the
"Outstanding Provider of the Year" award.  Announcements will be made at the 2009
DCFCCA Spring Conference.  

If you have any questions or need more information please call the DCFCCA voice
mail at 952- 985-3495 or email us at MLFCCArep@dcfcca.org.
Dakota County Family Child Care Association
P.O. Box 22065
Eagan, MN  55122
952-985-3495

Provider of the Year – 2009 Nomination
“Provider of the Year” recipients must meet the following requirements:

1)  Actively licensed for a minimum of three (3) years.
2)  Has not previously received this award within the past ten (10) years.
3)  Exhibits high standards as a child care provider.
4)  Has made a positive impact in the lives of young children.
5)  Continues to further his/her knowledge/skills as a child care provider.
6)  Does not have any pending negative licensing actions and has not had any substantiated
complaints within the last three years.


Thank you for supporting licensed family child care by nominating your provider for this year’s
“Provider of the Year” award. All applications will be reviewed by a committee made up of previous
recipients, parents, and county licensing staff. All nominated providers and the finalists will be
recognized at the 2009 DCFCCA Conference.