Note: This worksheet is not the license application. Rather, it is your first step on the road to licensure.

4C For Children has a contract with the State of Wisconsin to provide free assistance to help you obtain your child care license. The contract provides for a technical consultant from your local Child Care Resource and Referral to review a draft of the policy you develop, telephone and email support, and a visit to your site.

Please complete the information below.

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* 1. Contact Person (applicant):

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* 2. Proposed child care center business name (optional):

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* 3. Address of child care program

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* 4. County ~ Not finding your county? Please visit https://wisconsinearlychildhood.org/programs/pre-licensing/

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* 5. Mailing Address, if different:

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* 6. Phone number:

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* 7. Alternate phone number:

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* 8. Best time to contact you between 8:00 a.m. and 5:00 p.m.:

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* 9. Email address that you check daily:

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* 10. Program size:

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* 11. Groups you plan to serve (check all that apply):

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* 12. Programming options you plan to offer (check all that apply):

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