DUE NOVEMBER 7, 2014

PLEASE ENTER INFORMATION ABOUT EACH LICENSED SITE WHERE YOU OFFER GSRP PROGRAMMING. IF YOU HAVE MULTIPLE SITES, YOU WILL NEED TO SUBMIT MULTIPLE FORMS.
Complete this form for each site:
mm/dd/yyyy
mm/dd/yyyy
Help for Explain if not regular license Explan status of the site does not have a regular license, or if the regular license has been extended.
Help for Site Administrator Name This person has the responsibility to hire staff and /or perform annual evaluations
Help for Developmental Screener Used Identify the comprehensive, standardized developmental screening tool used at this site:
Help for If other, please describe. If developmental screening tool other than the above is in use, please describe.
Help for If other, describe If curriculum other than above will be used, please describe.
Help for Ongoing Child Assessment Identify the comprehensive, ongoing child assessment tool used at this site.
Help for If other, describe If comprehensive ongoing child assessment tool other than above will be used, please describe.
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