Name of Nominee

Address

City

Telephone Number

Your Name

Address

City

Telephone Number
Zip Code
Zip Code
How long has your child/children 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
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)  COMMUNICATION
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)  TRAINING
Does your child care provider EXCEED the 8 hours of required training each year?
No
Yes
For questions 5 and 6 below, please only TYPE or PRINT clearly 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 in 2010?
(Maximum of 10 lines please)
6)  Why do you feel your provider should be recognized as one of the 2010
"Outstanding Provider's of the Year?"  
(Maximum of 28 lines please)
7)  If you would like to be contacted regarding this application, please leave a phone
number where you can be reached:
Your provider will receive a copy of this nomination form.

All forms, both online and mailed, must be submitted by December 31, 2010 to be
considered for the 2011 “Outstanding Provider of the Year” award. Applications can
be submitted throughout the year and will be held until judging occurs in early 2011.
Announcement of the recpients will be made at the 2011 DCFCCA Spring Conference
in March. If you have 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 – 2011 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 five (5) 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 five (5) years.

Thank you for supporting licensed family child care by nominating your provider for this year’s
“Provider of the Year” award.  A committee made up of previous recipients, providers and parents
will review and score all applications.  All nominated providers and the finalists will be recognized at
the 2011 DCFCCA Spring Conference.  Not answering a question will affect your provider's score,
please do your best to find the answers to all questions.