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.

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* 1. Childcare Facility Name

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* 2. Childcare Facility Type (Family Childcare Home, Head Start, Corporate, etc.)

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* 3. Star Rating

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* 4. NC Pre-K Site

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* 5. Meals

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* 6. Name of Catered Meal Company (if catered meals chosen on #5)

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* 7. Our child care facility has permission to make changes to our property

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* 8. Is your childcare facility in operation 12 months a year

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* 9. Number of teaching staff currently working with children ages birth to 5 (not including kindergartners)

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* 10. Total # of children enrolled (ages birth-5 years)

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* 11. # of children enrolled up to 12 months of age

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* 12. # of children enrolled ages 1-2

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* 13. # of children enrolled ages 3-5

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* 14. # of children birth-5 years currently receiving subsidy

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* 15. Has your center ever participated in any of the following health-related plans? (Yes or No)

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* 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.

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* 17. Does your facility have an edible garden that is used as an educational tool?

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* 18. Does your facility have an edible garden that produces food for meals and snacks?

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* 19. Does your facility have a culturally relevant curriculum that addresses racial equity?

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* 20. Do parents lead or support Farm to ECE activities?

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* 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?

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* 22. Do classrooms cook with or taste local food at least 2 times a year?

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* 23. Does your kitchen use local food as part of meals or snacks at least two times a year?

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