PU URPOSE INS

S
Sample
e Renew
wal Ma
aterials
PU
URPOSE The purpose
p
of the Renewal Materials is to ensure that program
ms continue to meet all Candiidacy Requirem
ments. For mo
ore information,,
visit th
he NAEYC Aca
ademy website
e and click on Pursuing
P
Accre
editation or Rea
accreditation.
INS
STRUCTIO
ONS
Use this form to doccument all requ
uired informatio
on, including requested docum
mentation ONL
LY; do not subm
mit additional in
nformation (i.e.
award
ds, handbooks, photographs, etc.) which ma
ay be reviewed
d during the site
e visit for renew
wal.
acilitate timely
y processing of
o your materia
als, please do
o not staple, do
o not place pa
ages in plastic
c sleeves, and
d do not spiral
To fa
bind or collate matterials into no
otebooks or binders.
gram Information (Pages 2-3)
Prog
Section 2:
ensing/Regulation (Pages 4-5
5)
Lice
Section 3:
gram Schedule
e (Pages 6-7)
Prog
Section 4:
oup Information
n (Pages 8-10)
Gro
Section 5:
gram Administrator (Pages 11-15)
Prog
Section 6:
aching Staff Qu
ualifications (Pa
ages 16-17)
Tea
Section 7:
al Questions (P
Pages 18-19)
Fina
Section 8:
hts and Responsibilities (Pag
ge 20)
Righ
Section 9:
es for NAEYC Accreditation
A
(P
Page 21)
Fee
Section 10:
Payyment Information (Page 22)
SA
Section 11:
M
PL
Section 1:
E
TAB
BLE OF CONTENT
C
S
bmission Instructions (Page 22)
Sub
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
Sample Renewal Materials,
M
P
Page
2 of 22
2 Sec
ction 1: PROGRAM
P
M INFORM
MATION
Prog
gram Identification
Progrram Name:
Legal name to appearr on all correspon
ndence and officiial documents fro
om NAEYC, inclu
uding the NAEYC
C Accreditation Certificate.
C
Progrram ID#:
Secondary Conta
act
The Designated
D
Prog
gram Administra
ator is responsib
ble for receiving
written
n correspondencce regarding the program's
p
accred
ditation and can
update
e NAEYC with ch
hanges to progra
am information. See Clarification
n on
Progra
am Administratorr for more inform
mation.
The Seco
ondary Contact will be copied on
n all corresponde
ence regarding
the progra
am's accreditatio
on and can updatte NAEYC with changes
c
to
program information.
i
Name
e:
Name:
Title:
Title:
Phone: (
)
-
Fax: (
)
-
Phone: (
)
-
Faxx: (
)
-
Email:
Additional Con
ntacts
M
PL
Emaill:
E
Designated Pro
ogram Adm
ministrator
Additiional Contacts are
a authorized to
o receive confide
ential programma
atic information frrom NAEYC. Prrograms may nam
me up to three (3
3) additional
contaccts.
Name
e:
Title:
Na
ame:
Name:
Title:
Title:
Multtiple Progra
ams within
n the Same Facility
NAEY
YC Accreditation is granted to the overall program
m, and will not be granted to indiviidual classroomss within a program
m. Throughout the
t NAEYC
Accred
ditation process, all eligible group
ps a program serrves must be rep
ported and may be
b observed duriing a site visit. This
T
includes grroups within
the prrogram that ope
erate during the
e summer and after-school care
e groups.
SA
A grou
up can only be exxcluded from a program’s
p
NAEY
YC Accreditation if
i it is part of a se
eparate program that has a separrate public identiity. A program
pursuiing NAEYC Accrreditation must notify NAEYC of all
a separate prog
grams that operatte within its faciliity and be able to
o demonstrate a separate
budge
et, administration
n, license and/or other criteria. Co
omplete the inforrmation below to
o inform NAEYC of other program
ms that operate within
w
your
progra
am’s facility.
My prrogram is the only
o
program th
hat operates within its facility.
Yes
No
NOTE
E: If “yes” is checked above, and your
y
program offfers a summer ca
amp option or affter-school care groups,
g
these gro
oups must be rep
ported and may
be obsserved during a site
s visit.
In add
dition to my pro
ogram, one or more programss operate within the same faccility.
Yess
No
If yes, use the space
e below to list other
o
programss that operate within
w
your program’s facility and describe how
h
other existing programs
are se
eparate from yo
our program. Include
I
relevan
nt information about
a
how all other
o
existing programs have a separate nam
me, budget,
admin
nistration, and//or license from
m your program
m.
If nece
essary, you may attach an additio
onal page to con
ntinue your descrription of separatte programs that operate within your
y
program’s fa
acility.
Security Cleara
ance
Is a security
s
clearan
nce required up
pon entry to the
e program?
No
Yes – If yes, provide
e the name and
d phone numbe
er for the prope
er authority outsside of your pro
ogram below.
If yes, a security cleara
ance must be giv
ven prior to an an
nnounced or una
announced site visit,
v
please proviide the name and
d phone numberr for the proper
authorrity outside of your program.
Name
e:
Email:
Relationship to prog
gram:
Phone: (
)
-
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
Sample Renewal Materials,
M
P
Page
3 of 22
2
Sec
ction 1: PROGRAM
P
M INFORM
MATION Continued
C
Prog
gram Addre
ess
Contact information wiill be posted on the
t NAEYC webssite when a program achieves NA
AEYC Accreditattion.
Stree
et Address:
Suite/dept/floor:
City:
State:
County: Country:
Phone: ( ) - Fax: (
Emaill: Website
e:
Zip
p:
)
-
Mailling Addres
ss
E
To be used for written correspondence
e to the program.
Sa
ame as program
m address
Stree
et Address:
State:
County: Emaill:
M
PL
City:
Suite/dept/floor:
Country:
Phone: (
Billing Address
s
Zip
p:
)
-
To be used for invoice
es sent to the pro
ogram.
Sa
ame as program
m address
Attention: Same as mailing
m
address This in
ndividual must allso be listed as th
he Designated Program
P
Administrator, Secondary
ry Contact, or an Additional Conta
act on page 1.
SA
Organ
nization Name (if different tha
an program nam
me):
Stree
et Address:
City:
Suite/dept/floor:
State:
County: Country:
Emaill:
Phone: (
Zip
p:
)
-
Fax: (
)
Ship
pping Addre
ess
To be used for the ship
pment of all NAE
EYC Accreditation Materials.
Sa
ame as program
m address
Same as mailing
m
address
Same as billing addrress
Stree
et Address:
Suite/dept/floor:
No P.O
O. Boxes acceptted
City:
State:
County:
Country:
Emaill:
Phone: (
Zip
p:
)
-
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
-
Sample Renewal Materials,
M
P
Page
4 of 22
2
Sec
ction 2: LICENSIN
L
NG/REGUL
LATION
Lice
ensing/Regu
ulatory Sta
atus (Includ
des program
ms that are
e license ex
xempt)
Progra
ams must be reg
gulated by the ap
ppropriate licensin
ng/regulatory bo
ody or in process of obtaining a liccense in order to
o become an App
plicant for
NAEY
YC Accreditation. Define the licen
nsing/regulation status based on the four options below.
O
Option
1: My program is lic
censed.
Apprropriate licensing
g bodies refer to state licensing agencies.
a
My program is lice
ensed by: State
e: with a:
Agency:
Full Licen
nse
Tempora
ary License
Provision
nal License
Other:
My program is lice
ense-exempt, but
b voluntarily liicensed.
No
Yes
Yes – if yes, indica
ate expiration date:
Lice
ense Number: E
My program’s licen
nse expires.
N
No
Phone: ( ) -
Sp
pecialist Name
e:
M
PL
OR
O
Option
2: My program
p
is regulated.
Apprropriate regulato
ory bodies refer to
o public agenciess such as a boarrd of education or
o the military.
My program is reg
gulated by: My program’s regu
ulation expires..
No
Y – if yes, indicate expiration
Yes
n date:
OR
O
Option
3: My program
p
is lic
cense-exempt,, eligible for licensure, and began the app
plication proc
cess to becom
me licensed.
The
e application pro
ocess for licensure was begu
un in: Month:
Agency: SA
With
h: State: Year:
Untill the program be
ecomes licensed, I verify that:
1)
The progra
am administratorr has reviewed th
he state’s licensin
ng requirements;
2)
The Board
d chair/president or owner has reviewed the state’s licensing requ
uirements;
3)
My program is voluntarily in
i compliance witth the state’s lice
ensing requireme
ents; and
4)
Upon regisstration of childre
en in the program
m, my program provides families with a copy of th
he state’s licensin
ng requirements,, informs
families that the program is
s license-exemptt, and informs families that the prrogram is volunta
arily in compliancce with the state’s licensing
requirements.
OR
O
Option
4: My program
p
is lic
cense-exempt,, and legally prohibited
p
from
m licensure.
I verrify that:
1)
The progra
am administratorr has reviewed th
he state’s licensin
ng requirements;
2)
The Board
d chair/president or owner has reviewed the state’s licensing requ
uirements;
3)
My program is voluntarily in
i compliance witth the state’s lice
ensing requireme
ents;
4)
Upon regisstration of childre
en in the program
m, my program provides families with a copy of th
he state’s licensin
ng requirements,, informs
families that the program is
s license-exemptt, and informs families that the prrogram is volunta
arily in compliancce with the state’s licensing
requirements;
5)
The progra
am has documen
ntation of fire and
d health inspectio
ons; and
6)
The progra
am will have com
mpleted a crimina
al background ch
heck on all staff and
a have complie
ed with state and
d federal law con
ncerning
backgroun
nd checks. In ad
ddition, the progra
am employs no individual
i
convictted of a crime invvolving sexual ab
buse or child abu
use or neglect.
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
Sample Renewal Materials,
M
P
Page
5 of 22
2
Sec
ction 2: LICENSIN
L
NG/REGUL
LATION Continued
C
Repo
orting on Licensing/R
L
Regulatory Status,
S
Crittical Incide
ents, and Major
M
Chang
ges
NAEY
YC-Accredited pro
ograms and prog
grams that have submitted an Ap
pplication (Step 2)
2 for NAEYC Acccreditation are re
equired to update
e NAEYC of
criticall incidents, suspe
ension or revoca
ation of license orr regulatory statu
us, and major changes according
g to the following timeframes. To
o meet upcoming
g
Candid
dacy and site vissit requirements for
f NAEYC Accre
reditation, a progrram must mainta
ain good standing
g in its licensing or regulatory sta
atus by having no
o
seriou
us issues of nonccompliance within
n the last year orr since its last insspection.
NO
OTIFY WITHIN
N 72 HOURS
S
REP
PORT WITHIN
N 30 DAYS
Progra
am staff must sub
bmit the 72- Hou
ur Notification forrm if the program
m
experiiences any of the
e following critica
al incidents that may
m impact
progra
am quality status:
Program staff
s
must inform
m NAEYC of all major
m
programma
atic changes
using the Self Report form
m.
Any suspension
s
orr revocation in
n program’s license or
regulatory status
Example
es of major ch
hanges include
e, but are not limited to:
•
•
om any cause
The death of any child fro
njury to any chilld that results in the child bein
ng
A critical in
admitted to
o a hospital Em
mergency Room
m for treatment
(whether trransported by the Emergencyy Medical
Response team, program
m, parent, or oth
her individual)
Any unusual incident invo
olving a lack of supervision
ut not limited to
o a child being left unattended
d
(such as bu
or leaving the
t facility alon
ne)
Any suspeccted physical or
o psychologica
al abuse of a
child at the
e program or by
y an individual that the child met
m
through the
e program.
Change in own
nership or vend
dor
New designate
ed program administrator
Change of location
Change to the
e physical facilitty or ground (due to damage,,
renovations, etc.)
e
Incorporation of
o a new age category
c
that was
w not
previously servved
Court order orr legal action
Change in gen
neral program information
i
Change in the
e primary or seccondary contacct for the
program or rellated contact in
nformation
Merge with an
n existing progrram
•
M
PL
•
•
•
•
•
•
E
d or could ha
ave compromised the
Any incident that did
essen
ntial health orr safety of any
y child, such as
a but not
limite
ed to:
•
•
•
•
List the date(s) in whicch your program submitted all app
plicable 72-Hourr Notification and/
d/or Self Reports to NAEYC within
n the past 12 mo
onths. If your
progra
am has experiencced any of the in
ncidents or chang
ges noted above,, appropriate nottification must be
e submitted imme
ediately.
SA
72-Ho
our Notificatio
on Form(s) Submitted
Dates off Self Report Form(s)
F
Subm
mitted
Datess Submitted:
Dates Su
ubmitted:
N/A - My program has not submitted any 72-H
Hour Notificatio
on
formss in the past 12 months.
N/A - My program has
h not submittted any Self Re
eport forms in
the past 12 months.
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
Sample Renewal Materials,
M
P
Page
6 of 22
2 Section 3: PROGRAM
P
M SCHEDU
ULE
Prog
gram Closu
ures
My program
m operates le
ess than 12 months/year.
m
My program op
perates 12 mo
onths/year.
•
OR
The prrogram begins serving chilldren on
The prrogram ends on
/ / .
•
/
/
.
Indicate
e the dates your program will be closed for the ne
ext 12 months. Begin
B
with the cu
urrent month and
d place an X overr the dates in eacch month in whicch
your prrogram will be clo
osed.
Month
h
Dates
s Closed
Select the current montth
Yearr
1
2
3
4
5
6
7
8
9
10
11
12
1
13
14
15
17
18
19
2
20
21
22
2
23
24
25
26
27
28
2
29
30
31
16
20
Ch
heck if program
m is closed for the
t entire montth
2
3
4
5
6
7
8
9
10
11
12
1
13
14
15
17
18
19
2
20
21
22
2
23
24
25
26
27
28
2
29
30
31
E
1
16
20
Ch
heck if program
m is closed for the
t entire montth
17
2
3
4
5
6
7
18
19
2
20
21
22
2
23
8
9
10
11
12
1
13
14
15
24
25
26
27
28
2
29
30
31
M
PL
1
16
20
Ch
heck if program
m is closed for the
t entire montth
1
17
2
3
4
5
6
7
8
9
10
11
12
1
13
14
15
18
19
2
20
21
22
2
23
24
25
26
27
28
2
29
30
31
16
20
Ch
heck if program
m is closed for the
t entire montth
1
17
2
3
4
5
6
7
8
9
10
11
12
1
13
14
15
18
19
2
20
21
22
2
23
24
25
26
27
28
2
29
30
31
16
20
Ch
heck if program
m is closed for the
t entire montth
1
17
2
3
4
5
6
7
8
9
10
11
12
1
13
14
15
18
19
2
20
21
22
2
23
24
25
26
27
28
2
29
30
31
16
20
SA
Ch
heck if program
m is closed for the
t entire montth
1
2
3
4
5
6
7
8
9
10
11
12
1
13
14
15
17
18
19
2
20
21
22
2
23
24
25
26
27
28
2
29
30
31
16
20
Ch
heck if program
m is closed for the
t entire montth
1
2
3
4
5
6
7
8
9
10
11
12
1
13
14
15
17
18
19
2
20
21
22
2
23
24
25
26
27
28
2
29
30
31
16
20
Check if program is closed for th
he entire month
h
1
2
3
4
5
6
7
8
9
10
11
12
1
13
14
15
17
18
19
2
20
21
22
2
23
24
25
26
27
28
2
29
30
31
16
20
Check if program is closed for th
he entire month
h
1
2
3
4
5
6
7
8
9
10
11
12
1
13
14
15
17
18
19
2
20
21
22
2
23
24
25
26
27
28
2
29
30
31
16
20
Check if program is closed for th
he entire month
h
1
17
2
3
4
5
6
7
8
9
10
11
12
1
13
14
15
18
19
2
20
21
22
2
23
24
25
26
27
28
2
29
30
31
16
20
Check if program is closed for th
he entire month
h
1
2
3
4
5
6
7
8
9
10
11
12
1
13
14
15
17
18
19
2
20
21
22
2
23
24
25
26
27
28
2
29
30
31
16
20
Check if program is closed for th
he entire month
h
Note th
hat NAEYC will not
n conduct site visits
v
on Federal Holidays, includiing New Year’s Day,
D
Birthday of Martin Luther Kin
ng, Jr., Washington’s Birthday,
Memorrial Day, Indepen
ndence Day, Labor Day, Columbu
us Day, Veteranss Day, Thanksgivving Day, and Ch
hristmas Day. Fo
or more informattion on Federal
Holidayys, refer to the U.S.
U
Office of Pers
sonnel Managem
ment.
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
Sample Renewal Materials,
M
P
Page
7 of 22
2
Sec
ction 3: PROGRAM
P
M SCHEDULE Contiinued
Hou
urs of Operation
Indicate the days of the week your prog
gram operates and
a time of day your
y
program ope
ens and closes each
e
day.
Prrogram is open 24 hours/day, 7 days a weekk
Days Open
Monday
Tuesday
Wednessday
T
Thursday
Friday
Saturday
Sundayy
Open
ning
Time
:
:
:
:
:
:
:
a.m.
a.m.
a.m.
a.m.
a.m.
a.m.
a.m.
p.m.
p.m.
p.m.
p.m.
p.m.
p.m.
p.m.
Closiing
Time
:
:
:
:
:
:
:
a.m.
a.m.
a.m.
a.m.
a.m.
a.m.
a.m.
p.m.
p.m.
p.m.
p.m.
p.m.
p.m.
p.m.
Age
e Categories Served
d
E
Each age
a category serrved by the progrram must be rep
presented in at le
east one group on
n the day of the site
s visit. For exxample, if a progrram serves
infantss and toddler/two
os, the NAEYC Assessor
A
must ha
ave the opportun
nity to observe att least one group
p containing infan
nts and one grou
up containing
toddle
ers/twos on the day
d of the site vis
sit.
Comp
plete the following
g chart to identify
y the age categories served by yo
our program and
d when each age category is in se
ession.
My program
M
PL
NAE
EYC Defined Age
A Categorie
es
(Age
e ranges for each
h of the age cate
egories overlap
for program
p
flexibilityy. Programs can
n choose the
age category that ap
pplies to children whose ages
fall within
w
the overlap
pping portion of the
t age
rang
ges.)
Infa
ant: birth - 15 months
SA
Tod
ddler/Two: 12 - 36 mon
nths
My progra
am
NEVER serves
this age cate
egory.
Pre
eschool: 30
0 months - 5 years
Kin
ndergarten: enrolled in a public
or private
p
kinde
ergarten
SOMETIM
MES serves
this age
e category.
My program
M
A
ALWAYS
serrves this age
category.
C
Check
ONE of the
t appropriate
e boxes for eacch age categoryy:
Indica
ate all timefram
mes during whicch
infants are NOT servved:
Indica
ate all timefram
mes during whicch
toddle
ers/twos are NO
OT served:
Indica
ate all timefram
mes during whicch
preschoolers are NO
OT served:
Indica
ate all timefram
mes during whicch
kinderrgartners are NOT
N
served:
NOTE
E: Children within
n all eligible grou
ups a program se
erves must be rep
ported. This inc
cludes children from groups th
hat operate duriing the summerr
and after-school care
e groups.
Add
ditional Infformation
Note any
a special circumstances rega
arding your progrram’s schedule that
t
may affect th
he scheduling of a site visit.
Do no
ot exceed the spa
ace provided.
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
Sample Renewal Materials,
M
P
Page
8 of 22
2
Sec
ction 4: GROUP
G
IN
NFORMAT
TION
Sum
mmary of Groups
Pleasse report on all elligible groups your program serve
es. Refer to Clarrification on Grou
ups to determine
e how many grou
ups your program
m serves and the
age categories
c
that ap
pply to each grou
up. Direct questiions about how to
t report on group
ps within your prrogram to 1-800--424-2460, option
n 3, option 1.
# of
# of
Part Da
ay Groups
F Day Group
Full
ps
(meet for <5 hrs)
(meet for ≥5 hrs))
Infan
nt Group(s)
Todd
dler/Two Group
p(s)
Prescchool Group(s))
Kinde
ergarten Group
p(s)
Mixed
d Age Group(ss)
Total # of
Grou
ups
E
Age Catego
ories
M
PL
TOTAL of all groups:
Do any children in this
t
program sp
peak languagess other than En
nglish?
No
o
Yes – The
T children sp
peak: If yess, how much tim
me do the child
dren in this prog
gram typically speak
s
a langua
age other than English?
all of th
he time
most of
o the time
sometiimes
never
Sate
ellite Locattions
SA
Only complete
c
this section if any of the
e groups are hou
used in a satellite
e location.
A pro
ogram with sate
ellite location must
m
meet the following
f
criteria:
1.
2.
3.
4.
5.
6.
Havve no more tha
an 2 satellite loccations
Loccation is within 5 mile radius
The
e satellite locattion/s enroll 60 or fewer childrren
One
e Program Adm
ministration
One
e Budget
One
e Public Identitty
Sate
ellite Site Address
A
1
Stree
et Address: City: Suiite/dept/floor:
State:
Zip
p: Sate
ellite Site Address
A
2
Stree
et Address: City: Suiite/dept/floor:
State:
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Zip
p: Progra
am ID #:
Sample Renewal Materials,
M
P
Page
9 of 22
2
Sec
ction 4: GROUP
G
IN
NFORMAT
TION Continued Comp
plete the followin
ng page with info
ormation about ea
ach of the eligible
e groups your prrogram serves. Make
M
a copy of the
t following pag
ge and complete
for ad
dditional groups served at your program.
Gro
oup Name
Gro
oup Address
s
This group is locate
ed in:
T main facilitty listed as the site address
The
S
Satellite
Site 1
S
Satellite
Site 2
E
Age
e Categorie
es Served by
b this Grou
up
Pleasse check ALL th
hat apply:
T
Toddler/Two
P
Preschool
K
Kindergarten
M
PL
Infant
Num
mber of Tea
aching Staff Members
s Present in
n this Grou
up
NAEY
YC defines teach
hing staff by the roles
r
the fill withiin the group. Ple
ease refer to the Definition of Tea
aching Staff for more
m
information.
Num
mber of teacherss: Num
mber of assistan
nt teacher-teac
cher aides: SA
Gro
oup Characteristics
Numberr of other adultts (if any): How often arre they present? What is their role?
Do any
a children enrolled in this grroup have any of the following
g diagnosed sp
pecial needs?
If yess, please indicate
e the number of children.
c
O
Orthopedic
han
ndicaps: S
Speech
& langu
uage: N
Neurological
dissorders: D
Down
Syndrom
me: L
Learning
disabiilities: A
ADHD:
H
Hearing
impairm
ment: Autiism, spectrum disorders: Men
ntally disabled//Developmenta
ally Delayed: Maintenance care diseases (diab
betes, HIV): Visu
ual impairment: Beh
havioral: Other, specify:
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
Sample Renewal
R
Ma
aterials, Pa
age 10 of 22
2
Sec
ction 4: GROUP
G
IN
NFORMAT
TION Conttinued
Place an X in the
P
e box during the hours
h
that the grroup begins and end each day; se
erves meals or
s
snacks;
takes na
aps/rest; and uses the playground
d or a gross moto
or activity room.
Group
p Name:
6 AM
7 AM
8 AM
9AM
10 AM
11
1 AM
12 PM
1PM
2 PM
3 PM
4 PM
P
5 PM
Mon
nday
Exam
mple: Meals
X
X
X
Begin
n/End Time*
Meals
N
Nap/Rest
Tues
sday (if differrent than abov
ve)
Meals
N
Nap/Rest
Playg
ground/Gross
Motor
M
PL
Startt/End Time*
E
Playg
ground/Gross
Motor
Wed
dnesday (if diifferent than above)
a
Startt/End Time*
SA
Meals
N
Nap/Rest
Playg
ground/Gross
Motor
Thurrsday (if diffe
erent than abo
ove)
Startt/End Time*
Meals
N
Nap/Rest
Playg
ground/Gross
Motor
Frida
ay (if differen
nt than above))
Startt/End Time*
Meals
N
Nap/Rest
Playg
ground/Gross
Motor
*Startt/End Time is not
n applicable and
a can be left blank if group is in operation 24 hours/day.
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
6 PM
7 PM
Sample Renewal
R
Ma
aterials, Pa
age 11 of 22
2
Sec
ction 5: PROGRAM
P
M ADMINISTRATO
OR
For asssistance comple
eting pages 11-1
15, refer to criteriia 10.A.02 and 10.A.04 in TORCH
H as well as the Candidacy Requ
uirements on the
e Academy
websiite.
Name of Designate
ed Program Adm
ministrator: Progrram administrator qualifications (10.A.02) must be
e met as part of the
t Candidacy Requirements.
R
Wh two or more individuals sharre program
When
admin
nistrative responssibilities, at leastt one person musst meet the qualiifications outlined
d in criterion 10.A
A.02 and is conssidered the designated program
admin
nistrator. There are
a three differen
nt ways that a pro
ogram administra
ator can meet 10
0.A.02. Indicate how
h
the (designa
ated) program ad
dministrator
meetss the qualification
ns as outlined in Criterion 10.A.0
02 by completing form A, B, or C. Complete only ONE form. If form
m A or B are com
mpleted, you
must attach documen
ntation, for example a copy of the degree com
mpleted specifyiing discipline an
nd/or transcriptts.
A Has at least a baccalaurea
A.
ate degree with
h 24 credits in ECE,
E
CD, ElEd
d or EC Spec Ed
E AND 9 credits in administra
ation,
leade
ership, or mana
agement. (Com
mplete FORM A on page 12
2 and attach do
ocumentation
n; do not comp
plete FORM B or C.)
B Has plan in place to meet the
B.
t qualifications outlined in Option
O
A within
n 5 years. (Com
mplete FORM B on page 15
5 but no
docu
umentation ne
eeds to be atta
ached; do not complete FOR
RM A or C.)
E
C Meets the alternative pathw
C.
way – must document a total of 100 points across
a
all 3 cattegories: educa
ation, administrrator
experience and rele
evant training or
o credentials. (Complete FO
ORM C on pag
ges 13-14 and attach docum
mentation; do not
n complete
FORM A or FORM B.)
Form
mA
M
PL
Use th
his form ONLY to
o document that the designated program
p
adminisstrator has at least a baccalaurea
ate degree with 24
2 credit-bearing hours of
specia
alized college-levvel course work in early childhoo
od education (EC
CE), child develop
pment (CD), elem
mentary educatio
on (ElEd), or earlly childhood
specia
al education (EC
C Spec Ed) that addresses
a
child development
d
and
d learning from birth through kind
dergarten AND 9 credit-bearing ho
ours of
specia
alized college-levvel course work in administration
n, leadership, or management.
m
D
Documentation
t support FORM A must be attached and
to
imme
ediately follow FORM
F
A.
Bacca
alaureate Degre
ee or Higher: Lis
st the baccalaure
eate degree or hiigher degree recceived below. Ind
dividuals who ho
old an international degree must
submit an evaluation and
a verification of
o US equivalenccies. Attach a co
opy of the degre
ree and/or transcripts showing completion and
d discipline
imme
ediately followin
ng this page.
D
Degree
Name of
o College/University
Date
Major
SA
Crediit Hours: List the
e courses that co
omprise the 24 crredits in ECE, CD
D, ElEd, or EC Spec
S
Ed and/or th
he 9 credits in ad
dministration, lea
adership, or
mana
agement. This ma
ay include course
ework obtained as
a part of the deg
gree or courses completed separrately. If it is ap
pparent that the degree listed
above
e is in administr
tration/managem
ment (for examp
ple an MBA), yo
ou do not need to
t list the 9 cred
dits in administrration. If the de
egree is in ECE,
E,
CD, ElEd,
E
or EC Spec Ed, then you do
d not need to list
l the 24 crediits in ECE. If the
e degree is not in
n administration, leadership, or management,
m
ECE, CD, ElEd, or EC
C Spec Ed (for ex
xample Psycholo
ogy), you would need
n
to list 24 cre
redits in ECE and
d 9 credits in adm
ministration, lead
dership, or
mana
agement. Attach
h a copy of the relevant
r
transcrripts immediately following this
s page. Please highlight applic
cable courses on
o the
transcript.
C
Credits
Cours
se name
C
College/Univer
rsity
State
Date com
mpleted
END OF FORM A—
—Insert docum
mentation for Form
F
A HERE and proceed to page 15.
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
Sample Renewal
R
Ma
aterials, Pa
age 12 of 22
2
Sec
ction 5: PROGRAM
P
M ADMINISTRATO
OR Continued Form
mB
Use th
his form ONLY to
o document that the designated program
p
adminisstrator has a plan
n in place to have
e at least a bacccalaureate degree
e with 24 credits
in EC
CE and 9 credits in
i administration,, leadership, or management
m
with
hin five years. No
N additional do
ocumentation to
o support Form B is needed.
SA
M
PL
E
Desccribe Plan: Do no
ot exceed the spa
ace provided and
d do not attach additional
a
informa
ation.
END OF FORM B—
—No additiona
al documentattion needs to be
b attached fo
or Form B. Prroceed to page
e 15.
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
Sample Renewal
R
Ma
aterials, Pa
age 13 of 22
2
Sec
ction 5: PROGRAM
P
M ADMINISTRATO
OR Continued Form
mC
Use this
th form ONLY to
t document thatt the designated program
p
adminisstrator has met an
a alternative patthway to achieve
e the educationall qualifications off
a prog
gram administrattor. Documenta
ation to supportt Form C must be
b included imm
mediately follow
wing Form C.
For asssistance comple
eting Form C, refer to the Alterna
ative Pathway to Achieve Educatitional Qualificatio
ons of a Program
m Administrator
Form
mal Education: List
L degrees comp
pleted. Attach a copy of the deg
gree and/or transcripts showing co
ompletion and diiscipline. Individ
duals who hold
an intternational degre
ee must submit an
a evaluation and
d verification of US
U equivalenciess. You must be able
a
to document educational exp
periences
equalling a minimum of
o 50 points and a maximum of 70
0 points for formal education, usiing the following values:
Baccalaureate degre
ee or higher in ea
arly childhood ed
ducation, child de
evelopment & fam
mily studies, earl
rly childhood special education,
ation that encomp
passes developm
ment and learning of children birth
h through kinderrgarten; but lackin
ing 9 credit
or ellementary educa
hourrs in leadership, management an
nd/or administratiion
65 po
oints
Baccalaureate degre
ee or higher in ed
ducational leadership, management or a related field
f
(human servvices administrattion, business
ministration, organ
nizational develo
opment, public ad
dministration) bu
ut lacking 24 cred
dit hours that enccompass develop
pment and
adm
learn
ning of children birth
b
through kind
dergarten
60 po
oints
Baccalaureate degre
ee or higher in ECE-related field (social work, psyychology) withou
ut 24 credit hourss that encompasss development
dren birth through
h kindergarten an
nd without 9 cred
dit hours in leade
ership, managem
ment, and/or administration
and learning of child
55 po
oints
Asso
ociate degree in ECE/CD
50 po
oints
Baccalaureate degre
ee or higher in an
ny other field
M
PL
De
egree
Name of Co
ollege/Univers
sity
Points claimed:
E
70 po
oints
Sttate
Datte
Major
Atta
ach a copy of the degree an
nd/or transcrip
pts showing completion and
d discipline
imm
mediately follo
owing this pag
ge.
50 po
oints
40 po
oints
30 po
oints
25 po
oints
15 po
oints
SA
Expe
erience: List relevant work experiience here. You must
m
be able to document
d
work experiences
e
equ
ualing a minimum
m of 15 and a maxximum of 50
pointss using the follow
wing values:
At le
east 5 years expe
erience as a prog
gram administrattor that includes leading a progra
am through and maintaining
m
NAE
EYC
Accrreditation for at le
east 2 years
At le
east 3 years expe
erience as a prog
gram administrattor that includes successfully leading the program
m through the NA
AEYC
Accrreditation proces
ss (at least 12 mo
onths prior to vissit)
At le
east 3 years expe
erience as a prog
gram administrattor in an NAEYC
C-Accredited prog
gram that include
es maintaining acccreditation
without a lapse
At le
east 5 years expe
erience as a prog
gram administrattor in a program not accredited by
b NAEYC
At le
east 3 years expe
erience as a prog
gram administrattor in a program not accredited by
b NAEYC
Adm
ministrative
Position
Points claimed:
Prrogram Name
City, State
Date hire
ed
e ended
Date
(MM/YYY
YY)
(MM
M/YYYY)
No additional
a
doc
cumentation related
r
to expe
erience is required.
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
NAEYC
Accredited?
Sample Renewal
R
Ma
aterials, Pa
age 14 of 22
2
Sec
ction 5: PROGRAM
P
M ADMINISTRATO
OR Continued Form
m C Contin
nued
Relev
vant Training/Crredentials: List relevant training
g/credentials rela
ated to early child
dhood education,, child developme
ent, early childho
ood special
educa
ation, elementaryy education, prog
gram administrattion, leadership, or management.. You must be able to document a minimum of 5 points and a
maxim
mum of 35 pointss in relevant train
ning/credentials outside
o
of the forrmal education lissted on page13. Please list only training/cred
dentials
requiired to meet the
e alternative patthway for Candiidacy. Documen
ntation must be attached.
List of
o Relevant Cred
dits: One college
e credit equals fo
our points. Docu
umentation mus
st be attached.
Course name
College/Un
niversity
Sttate
Date completed
M
PL
E
Cre
edits
List of
o Relevant Traiining Hours: Four contact hours of training within
n the past 5 yearrs equals one point. Contact hourrs refer to training
g hours, rather
than hours
h
working in a classroom witth children. Docu
umentation mus
st be attached.
Sp
ponsoring ins
stitution/progrram
To
otal time (hours) in
training witth
instructorr
SA
Name of Training
T
Relev
vant Credentials
s: State directorr credentials thatt are NAEYC app
proved equal 35 points.
p
Docume
entation must be attached.
Do yo
ou have a state
e director or ad
dministrator’s credential?
c
Points claimed:
No
Yes- Iff yes, from wha
at state?
Attach a copy
c
of any crredits, training
g, or credentia
als listed on page
p
14.
END OF FORM C—
—Insert docum
mentation for Form
F
C HERE
E and proceed to page 15.
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
Date completed
Sample Renewal
R
Ma
aterials, Pa
age 15 of 22
2
Sec
ction 5: PROGRAM
P
M ADMINISTRATO
OR Continued Add
ditional Adm
ministrative
e Staff (Optional)
Pleasse provide additio
onal information about any other administrative sttaff and their role
es at your progra
am, which you be
elieve assist in prroviding context
aboutt the program’s operations.
o
(This
s question is optiional because NA
AEYC does not have
h
requiremen
nts for the qualificcations of these staff.)
s
SA
M
PL
E
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
Sample Renewal
R
Ma
aterials, Pa
age 16 of 22
2
Sec
ction 6: TEACHIN
T
NG STAFF QUALIFIICATIONS
S
Des
scription off Profession
nal Develop
pment Plan
n
Checkk all relevant types of professiona
al development for
f teaching stafff that is supporte
ed by the program
m and describe th
he overall plan in
n one or two
sente
ences.
E
Education
progrrams
T
Training
programs
T
Tuition
reimburssement
In
n-service training
M
Mentoring
A
Attendance
at conferences
c
O
Other
SA
M
PL
E
Desccribe Plan: Do no
ot exceed the spa
ace provided and
d do not attach additional
a
informa
ation.
The
e National Registry
R
Alliance (TNR
RA)
M program is located in OK, MO, ME, or WI
My
W and has attached documen
ntation from The National Reg
gistry Alliance (TNRA)
(
on the
desig
gnated adminisstrator and/or te
eaching staff qu
ualifications. NAEYC
N
has permission to sha
are our program
m’s contact info
ormation with
TNRA
A.
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
Sample Renewal
R
Ma
aterials, Pa
age 17 of 22
2
Section 6: TE
EACHING STAFF QUALIFIC
Q
ATIONS Continued
C
Complete
e a copy of page
e17 for each teac
ching staff memb
ber.
Teachin
ng Staff Name:
Group Name: If teachiing staff memb
ber works with other
o
groups, please
p
list:
Job Title
e (Choose one of
o the following):
Tea
acher (primary responsibility
r
for a group of childrren)
Tea
acher Assistantt/Aide (works unnder the direct suupervision of a teeacher)
Docum
mentation of
o Teaching
g Staff Edu
ucational Qualification
Q
ns
1. Attach
h documentation immediately follo
owing this page for
fo each teaching staff member sh
howing all relevan
nt educational qua
alifications listed.
2. Chec
ck the box(es) ne
ext to all evidence
e you are submittting.
3. Circle
e the letter(s) off all options the te
eacher fully meetss in the “Option” column.
c
Highligh
ht information as indicated.
i
Teachin
ng Staff Memb
ber has this qu
ualification:
Must Pro
ovide this doc
cumentation: (check
(
all that ap
pply)
Equivale
ent of an AA de
egree in ECE
Equivale
ent of a BA deg
gree in ECE
a copyy of the transcrript that specifie
es major and reflects that
the degre
ee was earned (highlight major)
r)AND/OR
a copyy of the diplom
ma that lists the major field of study
s
F
M
PL
Associa
ate’s degree (AA
A) OR
Baccala
aureate degree
e (BA) or higherr in
• Early Childhood Edu
ucation (ECE),
• Child Development (CD),
• Eleme
entary Educatio
on (El Ed), OR
R
• Early Childhood Spe
ecial Ed ( EC Spec
S
Ed )
C
Always su
ubmit the CDA (iff the teaching sta
aff member has earned
e
it) in
addition to
o other qualificatiions/credentials.
E
A curren
nt Child Develo
opment Associa
ate (CDA)
credential awarded byy the Council fo
or Professional
Recognition
Circle Optio
on:
a copyy of the CDA credential
c
award
ded by the Cou
uncil for
Professio
onal Recognitio
on
H
I
J
SA
• AA de
egree or higherr in a non-ECE
E related field
AND
• at lea
ast 3 years expe
erience in an NAEYC
N
Accre
edited program.
Transcrip
pts documentin
ng (highlight creddits):
at leasst 60 college/university creditts
INCLUDIING at least
30 creditss in ECE, CD, El Ed, or EC Spec
S
Ed*
a copyy of the diplom
ma reflecting tha
at the degree was
w completed
AND
a copy of a tra
anscript reflecting a BA degree in any
discipline
e, WITH
at least 36 creditss in ECE, CD, ElEd, or
ECSpecE
Ed*. (highlight crredits)
a copyy of the degree
e OR
a tran
nscript that refle
ects the
degree was
w earned AND
a resume
e or letter that includes the
program name, location
n, length of emp
ployment, role constituting 3
years of experience,
e
an
nd note that the
e program was//is accredited
by NAEY
YC during employment.
a copyy of the degree
e OR
a tran
nscript that refle
ects the
degree was
w earned AND
a resume
e or letter that includes the
program name, location
n, length of emp
ployment, and role
constituting 3 years of experience;
e
AN
ND
docume
entation of 30
contact hours
h
of relevan
nt training from
m the last 3 years.
a transcript documen
nting 12 ECE* credits (highlighht credits) OR
docum
mentation from a college/university that wou
uld grant a
minim
mum of 12 credits for a specifie
ed training prog
gram OR
militarry training modules.
• AA de
egree or higherr in non-ECE re
elated field AN
ND
• at lea
ast 3 years expe
erience in a no
on-accredited
progra
am, AND
• at lea
ast 30 contact hours
h
of training
g
CDA cre
edential equiva
alent as defined
d by NAEYC ass
at least 12 college credits in ECE, CD
D, El Ed, or EC
C
Spec Ed
d
Working
g on an AA deg
gree or higher degree
d
in ECE,
CD, El Ed,
E or EC Spe
ec Ed
Working
g on the equiva
alent of an AA degree
d
or highe
er
in ECE, CD, El Ed, or EC Spec Ed
Working
g on the CDA credential
c
awarrded by the
Council for Professional Recognition
Working
g on the equiva
alent of the CDA
A credential (a
as
defined by NAEYC as 12 credits)
None off the above qua
alifications app
ply.
K
D
“Working on”
o means some
e evidence of edu
ucational progresss must be
within one
e year of the Candidacy Due date
e. This can includ
de work
scheduled
d to begin less than 1 year followiing the Candidaccy Due date.
Acceptable documentation
n that is dated wiithin one year of the Candidacy
Due date includes
i
one or more
m
of the follow
wing:
copy of
o an applicatio
on
copy of
o grade reportt
copy of
o transcript
letter from
f
an adviso
or
CDA preparation
p
cou
urse flyer
receipt of tuition paym
ment,
militaryy training modu
ules.
course
e description fro
om a course
catalog
E
G
A
B
Optionss A
and B a
are
available
e to
assista
ant
teache
er/
teache
er
aides o
only
NONE
No ad
dditional docum
mentation is included.
*ECE = Early
E
Childhood
d Education; CD
D = Child Develo
opment; ElEd = Elementary Ed
ducation; EC Spe
ec Ed = Early Childhood
C
Speciial Education
All colle
ege credits and degrees
d
must be
b from a region
nally accredited
d institution of higher
h
education
n. The U.S. Deptt. of Education maintains
m
a listing
g of
recognized accredited insstitutions of higher education at http://ope.ed.gov/
h
v/accreditation. In
nternational degrrees must be veri
rified through a process of matchiing
US equivvalent degrees.
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
Sample Renewal
R
Ma
aterials, Pa
age 18 of 22
2
Sec
ction 7: PROGRAM
P
M SELF-A
ASSESSMENT REPORT
Sou
urces of Eviidence Info
ormation
The Sources
S
of Evidence for all Criteria
C
have be
een updated ass of September 2008. Programs that submitt Renewal Mate
erials must
organ
nize their evide
ence according
g to the 2008 Sources of Evidence as listed below.
2008
8 Sources of Evvidence
•
•
•
•
•
Program Portfolio
Classroom Portfolios
s
Teach
hing Staff Survey
Family Survey
Obserrvable Criteria
Insttructions
Notes:
M
PL
E
To co
omplete Sectio
on 8: Program Self-Assessme
S
ent Report, all Sources
S
of Evid
dence created during Self-Assessment shou
uld be
comp
plete with labeled pieces of ev
vidence or com
mpleted summa
ary forms. Refe
erence your co
ompleted Sourcces of Evidence
e to answer
the fo
ollowing questions.
Not all criteria apply to alll age categorie
es. If you do not serve the ag
ge category to which
w
the criterion applies, ch
heck the
ve on to the next question.
appropriatte box and mov
•
Do not excceed the space
e provided as you
y complete each question. Doing so will decrease
d
the user-friendlinesss of these
Candidacyy Materials.
•
Do not atta
ach evidence to
o these materia
als. Simply rep
port on the evid
dence that you have collected
d throughout yo
our program’s
formal Self-Assessment.
SA
•
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
Sample Renewal
R
Ma
aterials, Pa
age 19 of 22
2
Sec
ction 7: FINAL
F
QU
UESTIONS
S
Do no
ot exceed the spa
ace provided.
M
PL
E
Whatt information do
oes NAEYC ne
eed to know to conduct an accurate assessm
ment of your prrogram (for exa
ample, any uniq
que
chara
acteristics of th
he facility, progrram, enrolled children,
c
or com
mmunity) when reviewing you
ur Renewal Matterials and duriing the site
visit?
?
SA
Are there any criterria with which your
y
program ca
annot comply because
b
the prrogram is subje
ect to a governmental rule tha
at does not
w you to meet itt? If so, please specify the critteria (letter and
d number) and attach docume
entation of the regulation thatt prohibits
allow
meetting the expecta
ation of the critterion.
Do no
ot exceed the spa
ace provided.
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
Sample Renewal
R
Ma
aterials, Pa
age 20 of 22
2
Sec
ction 8: RIGHTS
R
AND
A
RESP
PONSIBIL
LITIES
Prog
gram Rightts
Rightt:
Rightt:
Rightt:
Prog
gram Respo
onsibilities
s
Resp
ponsibility:
To understand the NAEYC Accreditation pro
T
ocess and acce
ess the most current
c
versionss of the NAEYC
C Early
C
Childhood
Prog
gram Standard
ds and Accredittation Criteria and
a related asssessment tools and resourcess.
F information
For
n about the NA
AEYC Accredita
ation process, visit
v
the NAEYC
C Academy We
ebsite frequenttly and read
m
monthly
Accred
ditation e-Upda
ates and bi-ann
nual Accreditation Updates.
F current verrsions of the NA
For
AEYC Early Ch
hildhood Progra
am Standards and Accreditattion Criteria and related
a
assessment
tools and resources, visit TORC
CH.
T Update NAE
To
EYC of program
mmatic change
es and critical incidents accorrding to the app
propriate timefrrames.
•
Report ma
ajor programma
atic changes within
w
30 days using
u
the Self Report
R
form.
•
Notify NAE
EYC of critical incidents that may
m impact pro
ogram quality status
s
within 72
2 hours using th
he 72 Hour
Notification
n form.
•
Inform NA
AEYC of update
es to contact information for th
he primary and
d secondary contact of your program to
ensure open communica
ation between the program an
nd NAEYC. Ch
hanges to conta
act information should be
reported as
a soon as posssible with the Self
S Report form
m.
T notify NAEY
To
YC immediatelyy if Candidacy Requirements reported on within these Ren
newal Materialss are no longerr
m
met.
Failure to
o meet Candida
acy Requireme
ents may affectt a program’s ability
a
to move forward
f
in the renewal
r
p
process
and/orr maintain statu
us as a currently NAEYC-Acccredited program.
T retain a cop
To
py of all forms submitted
s
to NA
AEYC and reta
ain documentattion verifying th
he date of all su
ubmissions.
P
Postmark
docu
umentation is acceptable
a
for submissions
s
byy mail and a co
opy of sent e-m
mail with date an
nd time stamp
i
information
is acceptable
a
for e-mail submisssions.
C
Completed
Renewal Materials and paymentt must be subm
mitted by the du
ue date chosen
n. If a program fails to submit
t Renewal Materials
the
M
and fe
ee by the selectted due date, then the progra
am will be withd
drawn as an Ap
pplicant for
N
NAEYC
Accred
ditation. If with
hdrawn, a progrram can re-app
ply by submittin
ng a new Appliccation and fee..
SA
Resp
ponsibility:
E
Rightt:
pport from NAE
EYC.
To receivve professional and timely sup
•
Phon
ne - (800) 424-2
2460, option 3,, option 1. Mon
nday - Friday, 9:00
9
AM to 5:0
00 PM ET
•
Email - accreditatio
[email protected]
@naeyc.org
•
Accre
editation Progrram Support Re
esources
To receivve information from
f
the NAEY
YC Academy regarding update
es on the NAEY
YC Accreditatio
on system, policies, and
procedure
es.
•
Montthly Accreditation e-Updates emailed
e
to prim
mary and secon
ndary contacts provided to NA
AEYC.
•
Bi-An
nnual Accredita
ation Updates mailed
m
to progrram mailing address provided
d to NAEYC.
To accesss current, accu
urate informatio
on about the NA
AEYC Accredittation process and the NAEYC Early Childhood Program
Standardss and Accredita
ation Criteria, including relate
ed assessment tools and reso
ources.
•
NAEY
YC Academy Website
W
•
TOR
RCH
To provide feedback to the NAEYC reg
garding the NA
AEYC Accredita
ation process and
a the NAEYC
C Early Childho
ood Program
Standardss and Accredita
ation Criteria.
•
Subm
mit Feedback on
o the Accredita
ation System
•
Subm
mit feedback on
n the accreditation criteria via
a TORCH Criteria Feedback and
a TORCH Discussions
AEYC Accredittation process at any time.
To withdrraw from the NA
M
PL
Rightt:
Resp
ponsibility:
Resp
ponsibility:
Resp
ponsibility:
Sign
nature
I have read an
nd understand my program’s rights and resp
ponsibilities.
I verify that the
e information submitted
s
in thiss form is accurrate. If false orr misleading infformation is evver provided to the NAEYC
Academy, I un
nderstand that my program’s pursuit of NAE
EYC Accreditatiion will cease and/or
a
my prog
gram’s current accreditation
a
may be revoke
ed.
I understand that
t
failure to fu
ully complete th
he Renewal Ma
aterials, provide
e the necessarry documentation as it relatess to the
educational qu
ualifications forr Candidacy, an
nd/or maintain the Candidacyy Requirementss may result in my program’s denial of
Renewal Mate
erials.
I understand that
t
the program
m must notify the
t NAEYC Aca
ademy of all sttaff changes prrior to a visit. (T
This includes changes
c
in the
program administrator designated in 10.A.0
02 or teaching staff).
________
____________
____________
_________
________
____________
____________
______
Signature
Title © 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
Sample Renewal
R
Ma
aterials, Pa
age 21 of 22
2
Se
ection 9: FEES FOR NAEYC
C ACCRED
DITATION
N
The
e Renewal Matterials fee is nonrefundable.
This
s form will nott be processed until NAEYC
C receives the
e applicable fe
ee.
Renewa
al
Materialls
Level
L
1
Level 2
Lev
vel 3
Level 4
(1
10 to 60
(61 to 120
(121 to 240
(241 to 360
children)
children)
children)
children)
$950
$1,275
$1,400
$1,550
Every additional
120 children
add $125
$
Currrently, NAEYC has
h a scholarship
p fund available to
t programs in fin
nancial need. If your
y
program is interested, pleasse review the sch
holarship
requ
uirements.
E
The accreditation fee
e is calculated ba
ased on the num
mber of children enrolled
e
in a prog
gram at the time this
t
form is subm
mitted. If the num
mber of children
chan
nges for a defined portion of the year
y
(for example
e, altered progra
am operation duriing the summer), the program sh
hould report the number
n
of
child
dren that typicallyy applies through
hout the majority of the school year. Programs willl be billed for sup
pplemental fees (according to the
e chart above)
if pro
ogram enrollmen
nt is inaccurately reported during the accreditation
n process.
M
PL
erence the follow
wing rules to determine the numbe
er of children tha
at determines the
e accreditation fe
ee for your progra
am.
Refe
•
•
Each child
d is only counted once.
•
For progra
ams with hourly care
c
or drop-in ca
are groups in which the total num
mber of children enrolled
e
in the gro
roup exceeds the
e maximum
licensing capacity
c
of the grroup, only the ma
aximum licensing
g capacity of the group is counted
d. Add the maxim
mum licensing ca
apacity of any
drop-in carre groups to the total number of children,
c
if appliccable.
Each child
d of eligible age (birth
(b
through kindergarten) that iss part of an eligib
ble group is coun
nted. All eligible groups MUST be included in
your progrram’s NAEYC Ac
ccreditation. Note
e that groups are
e not eligible if mo
ore than 50% of the children are school age (firstt grade and
beyond).
Age
A Category
Number of Children
C
Enrolled
In
nfant (birth to 15
1 months)
SA
Toddler/Twos
T
(1
12 to 36 month
hs)
Preschool
P
(30 months
m
to 5 yea
ars)
Kindergarten
K
(p
public or private
e)
TOTAL Num
mber of Childrren:
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
Sample Renewal
R
Ma
aterials, Pa
age 22 of 22
2
Sec
ction 10: PAYMEN
NT INFOR
RMATION
Choosse ONE method of payment and include applicab
ble information be
elow.
Check
Check Number:
Name
e on Checking Account:
Attach
h check to this form
If checck is sent under separate
s
cover, program
p
ID num
mber or other iden
ntifying informatio
on must be includ
ded on the checkk.
Purc
chase Orde
er
Purch
hase Order Num
mber:
Name
e on Purchase Order:
E
Attach
h purchase orde
er to this form.
If purcchase order is se
ent under separate cover, program
m ID number or other
o
identifying information musst be included on the purchase orrder.
V
VISA
MassterCard
Credit Card Numberr:
M
PL
Cred
dit Card
Amex
Credit Card Expiration Date: Montth: Ye
ear:
Name
e on card/checking account or
o purchase ord
der holder:
Card billing addresss:
City:
Country:
SA
Signa
ature:
State:
Zip
p:
Progra
ams who do not wish to provide their
t
credit card information
i
at thiis time may pay by
b phone, 1-800
0-424-2460, optio
on 3, option 1.
Sec
ction 11: SUBMISS
SION INS
STRUCTIO
ONS
Mail completed
c
forrm with payme
ent to:
NAEYC Academyy
P.O
O. Box 96036
Washington, D.C. 20090
0-6036
NAEY
YC accepts the postmark date as the submission date. NAEYC re
ecommends thatt programs obtaiin written confirm
mation of receipt of all forms sentt
to NAE
EYC P.O. Boxess. Please discus
ss tracking option
ns with your locall Post Office. NA
AEYC is not able
e to sign for mate
erials that are delivered to a P.O.
Box byy an individual co
ourier such as UPS
U
or FedEx.
Copy this form for your program’s reco
ords before subm
mission. NAEYC will not return th
his form to the pro
ogram.
© 2010. National Association for
f the Educa
ation of Young
g Children. All
A rights reserrved.
Progra
am ID #:
`