Quality First Application

Provider Type*

Center Child Care Provider

Family/Home-Based Child Care Provider (DES Certified)

If a home provider, does the person with the primary responsibility for the care of the children have a high school diploma/equivalent?*

Yes

No

Organization Name*

Site Name*

Name written on license.

Is your program part of a larger organization / corporation?*

Yes

No

Organization / Corporation Name*

What is the name of your parent organization / corporation?

District / Regional Manager Name*

District / Regional Manager Position / Title*

District / Regional Manager Email*

District / Regional Manager Phone*

Site Address*

Site Street Address Site City Site State Site Zip Site Country

Website

Mailing Address

Same as Site Address

Mailing Street Address Mailing City Mailing State Mailing Zip Mailing Country

Primary Contact

Primary Contact Name*

Contact First Name Contact Last Name

Primary Contact Title*

Primary Contact Phone*

No Primary Contact Email

My contact does not have an email address

Primary Contact Email*

Your Information (Person filling out this application)

Same as Primary Contact

Same as primary contact above

Your Name*

Your First Name Your Last Name

Your Title*

Your Phone*

Your Email*

Primary Program Designee

Same as Primary Contact

Same as primary contact above

Primary Program Designee*

Primary Program Designee First Name Primary Program Designee Last Name

Primary Program Designee Title*

Primary Program Designee Phone*

Primary Program Designee Email*

Are you a regulated program?*

Yes

No

Please list all license and/or certification numbers that apply to your program. Please enter license numbers according to the examples shown. Regulated means licensed, certified or monitored by Arizona Department of Health Services, Arizona Department of Economic Security, United States Department of Defense, United States Health and Human Services (Head Start Bureau) or Tribal Governments.

License Type*

DHS

DES

Both

DHS License #*

(Ex. CDC1234) (Ex. SGH5678) Please do not include any hyphens.

DHS License Expiration Date*

DES Certification #*

(Ex. P0001234)

DES License Expiration Date*

Tribal #

(Ex. Head Start Grant Number or CCDF Number)

Military #

Language(s) Used for Instruction (Check all that apply)*

English

Spanish

Other

Other Language*

How did you hear about Quality First?*

Please check all that apply.

Web site search

Regular mail

Email

Workshop or training

Friend or colleague

Community forum or event (not a training or workshop)

Consent for Program Assessment and Star Rating

If selected for participation in Quality First, you will be contacted to verify your program information and schedule an initial program assessment. A Quality First assessor will visit your program and conduct classroom observations and teacher interviews. The assessor will then complete a formal assessment report and determine your program’s scores on one or more assessment scales. These scores will be used to determine your Quality First Star Rating and the benefits and supports your program is eligible to receive. (Your initial star rating will not be made public).

Upon completion of your initial program assessment, you will be assigned a Quality First coach and have the opportunity to officially enroll in Quality First. Your coach will review the scores of your program assessments and your initial Quality First Star Rating, and together you will create a plan to improve the quality of your program.

If you choose not to enroll in Quality First, your program may be ineligible for other funding or services available through First Things First.

To submit an application online, click below to begin the process.

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Consent to Submit Application*

By checking this box, I the applicant, acknowledge that I have reviewed this application and affirm that all the information contained within it is true and accurate. I understand that all information will be verified prior to enrollment with Quality First!

Quality First Application

The Quality First Application

Primary Contact

Your Information (Person filling out this application)

Primary Program Designee

Consent for Program Assessment and Star Rating