Child Care Technical Assistance Intake Form

Do you have a question related to your child care program or the children in your care that you cannot find an answer to? The Child Care Council is available to provide technical assistance to family/group family child care providers and child care center and school age care staff. We can answer your questions and provide you with resources on many topics related to children and child care programming.

Complete this form, or call the Child Care Council, to receive research-based answers and resources to your questions!

Your Information:  


First Name: (required)
Last Name: (required)

Program Name: (required)

Address: (required)

City: (required)
State: (required)
Zip: (required)
Home Phone: (required)
Alternate Phone:

Email Address:

How would you like to receive your resources? (required)
(Be sure to include complete contact information for the way in which you are requesting to receive your referral.):
U.S. Mail
Email
Fax

     

My program is located in:

Herkimer County
Madison County
Oneida County
Other

I would like to receive resources on the following topic(s):

(required)
Contract writing
Lead prevention
Policies handbook for parent
Child behavior
Biting
Positive Discipline
Curriculum
Americans with Disabilities (ADA) law
Quality Indicators
Program Management
Bullying
Physical Indoor Activities
Room Arrangement
Nutrition
Parent Communication
Health & Safety
Childhood Allergies
School-Age Care
Marketing
Child Development
First Aid
Fire Safety
Other (specifiy)