Farm to ECE Child Care Facility Farm to ECE Site Information Please fill out the form below if you are interested in your child care facility participating in the Farm to ECE program. OK Question Title * 1. Childcare Facility Name OK Question Title * 2. Childcare Facility Type (Family Childcare Home, Head Start, Corporate, etc.) OK Question Title * 3. Star Rating OK Question Title * 4. NC Pre-K Site Yes No OK Question Title * 5. Meals On Site Meal Prep Catered Meals OK Question Title * 6. Name of Catered Meal Company (if catered meals chosen on #5) OK Question Title * 7. Our child care facility has permission to make changes to our property Yes No OK Question Title * 8. Is your childcare facility in operation 12 months a year Yes No OK Question Title * 9. Number of teaching staff currently working with children ages birth to 5 (not including kindergartners) OK Question Title * 10. Total # of children enrolled (ages birth-5 years) OK Question Title * 11. # of children enrolled up to 12 months of age OK Question Title * 12. # of children enrolled ages 1-2 OK Question Title * 13. # of children enrolled ages 3-5 OK Question Title * 14. # of children birth-5 years currently receiving subsidy OK Question Title * 15. Has your center ever participated in any of the following health-related plans? (Yes or No) Go NAP SACC Child Care Health Consultant Natural Learning Initiative Be Active Kids Other: Please Describe OK Question Title * 16. If applicable, list the date you began working with the program below. Also, supply whether the program is ongoing or the date the program ended. Go NAP SACC Child Care Health Consultant Natural Learning Initiative Be Active Kids Other OK Question Title * 17. Does your facility have an edible garden that is used as an educational tool? Currently Engaged in this activity Not currently participating in this activity but is interested in doing so Not currently participating and not interested in this activity OK Question Title * 18. Does your facility have an edible garden that produces food for meals and snacks? Currently engaged in this activity Not currently participating in this activity but is interested in doing so Not currently participating and not interested in this activity OK Question Title * 19. Does your facility have a culturally relevant curriculum that addresses racial equity? Currently engaged in this activity Not currently participating in this activity but is interested in doing so Not currently participating and not interested in this activity OK Question Title * 20. Do parents lead or support Farm to ECE activities? Currently engaged in this activity Not currently participating in this activity but is interested in doing so Not currently participating and not interested in this activity OK Question Title * 21. Is your facility connected to a local farmer through a farm field trip, a farmer visit to a classroom or to lunch, at least once a year? Currently engaged in this activity Not currently participating in this activity but is interested in doing so Not currently participating and not interested in this activity OK Question Title * 22. Do classrooms cook with or taste local food at least 2 times a year? Currently engaged in this activity Not currently participating in this activity but is interested in doing so Not currrenly participating and not interested in this activity OK Question Title * 23. Does your kitchen use local food as part of meals or snacks at least two times a year? Currently engaged in this activity Not currently participating in this activity but is interested in doing so Not currently participating and not interested in this activity OK DONE