Search: Child Care Center Provider Update Form PLEASE NOTE: Use the tab key to move from field to field. If you hit ENTER, the form could be submitted before you are finished. We do not want our name to be given out on referral lists at this time. We do not want our rates given out to parents. We are a newly licensed program. License Number: License Expiration Date: Business Information Center Name: Director's Name: Site Address: Mailing Address (if different): Primary Phone Number: Secondary Phone Number: FAX Number: Website: Email Address: Alternate Email Address: Total # of Staff: Program Information Ages Served From: Years Months Weeks Ages Served To: Years Months Weeks Yearly Schedule: Full Year School Year Only Summer Only Funding Sources: HeadStart Preschool for All Environment: Program is wheelchair accessible. Yard is fenced in. Schedule We open at: AM and close at PM Please check the following days that the center is open: Monday Tuesday Wednesday Thursday Friday Saturday Sunday We are willing to care for children: Full-time only Less than 5 hours per day Less than 5 days per week On a drop-in status Temporary/Emergency Status Before/After School On Holidays On a rotating basis School-age with younger sibling only Part-time care available for infants Day Full-Time Enrollment Infants: One's: Twos's: Threes's & Four's: Five's: School Age: Total Day Full-Time Vacancies: Evening Full-Time Enrollment Infants: One's: Twos's: Threes's & Four's: Five's: School Age: Total Evening Full-Time Vacancies: School & Transportation Assigned School District: The school bus transports to the following schools: Our center transports to the following schools: Our center is within walking distance to the following schools: Yes, Our program provides regular transportation To/From Child's Home. Addtional Information: Rates: Yes, we charge the Illinois State Rate to all families.          If this box is checked, it is not necessary to fill out the rates below. Infants Rate: $ per Month per Week per Day per Hour One's Rate: $ per Month per Week per Day per Hour Two's Rate: $ per Month per Week per Day per Hour Three's & Four's Rate: $ per Month per Week per Day per Hour Fives's Rate: $ per Month per Week per Day per Hour School age on school days Rate: $ per Month per Week per Day per Hour School age on non-school days Rate: $ per Month per Week per Day per Hour Additional Rate Information: Yes, we have multi-child discount Yes, we accept Child Care Assistance Payments Yes, we accept DCFS vouchers Yes, we have a sliding fee scale for families Yes, we offer scholarships to help cover the cost of care Yes, we charge when a child is absent due to vacation or holiday Yes, we charge when a child is absent due to illness Total # of children with special needs enrolled: Total Special Needs Count Staff has expeience working with the following types of special needs: Emotional/Behavioral Physical Developmental Sign Language (Fluent) Asthma Visual/Hearing Sensory Special Health Needs Autism Gifted Premature Infants Down Syndrome Other    Please Specifiy Center Staff Education High School/GED 2 Year Degree 4 Year Degree MA/MS or Higher Early Childhood Education Degree Health Degree   Please specify Special Education Degree ISBE Pre-K Certification Elementary Education Gateway Scholarship recipient At least one of our staff is fluent in: Spanish Sign Language Other    Please specify: Other Center Setting: For-Profit Non-Profit Faith-Based Work-place Based Parent Participation Accredited Site Preschool for All Please add any additional information about your program here For questions regarding filling out this form or being listed on the database, please contact 1-800-467-9200. Back to top