Virginia Beach GrowSmart

vbgrowsmart@vbgov.com

4525 Main Street Suite 700 Virginia Beach, VA 23462

Phone: (757) 385-0144

GROW v3 Program Info

This form is required for all programs participating in GROW v3 coaching. Thank you for completing this prior to coaching so we can get your program set up for success!

Child Care Program Name

Program ZIP Code

Program Director Phone Number

Program Director/Contact Email Address

Program Type

Program participates in the following (check all that apply)

Child and Adult Food Program (CACFP)

VQ/B5 Quality Impovement

DSS Subsidy Vendor

CLASS Rated in the past year

National Accreditation

Military Subsidy Vendor

Number of classrooms participating in GROW Coaching?

Classroom #1

Classroom #1 - Ages of Children?

2 years old

3 years old

4 years old

5 years old

Mixed ages: 2-5 years

Classroom #1 - Number of Children

Classroom #1: Lead Teacher Name

Classroom #1: Lead Teacher Email Address

Classroom #1: Lead Teacher Education Level

High school diploma

AA degree - community college

Bachelors degree - 4 years

Master's degree

Some college credits

Degree in early childhood, education or related field

Classroom #1: Lead Teacher Year's of Experience

Less than a year

1 - 4 years

5 - 9 years

10 - 14 years

15 - 19 years

20 or more years

Classroom # 1: Assistant Teacher Name

Classroom #1: Assistant Teacher Email Address

Classroom #2

Classroom #2 - Ages of Children?

2 years old

3 years old

4 years old

5 years old

Mixed ages: 2-5 years

Classroom #2 - Number of Children

Classroom #2: Lead Teacher Name

Classroom #2: Lead Teacher Email Address

Classroom #2: Lead Teacher Education Level

High school diploma

AA degree - community college

Bachelors degree - 4 years

Master's degree

Some college credit

Degree in early childhood, education or related field

Classroom #2: Lead Teacher Year's of Experience

Less than a year

1 - 4 years

5 - 9 years

10 - 14 years

15 - 19 years

20 or more years

Classroom #2: Assistant Teacher Name

Classroom #2: Assistant Teacher Email Address