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Center Provider Monthly Update
  1. Name of Center(*)
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  2. Director First Name(*)
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  3. Director Last Name(*)
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  4. Name of Director Designee(*)
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  5. Center Address(*)
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  6. City(*)
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  7. State(*)
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  8. Zip Code(*)
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  9. Phone(*)
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  10. Fax Number
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  11. Website
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  12. Email(*)
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  13. Mailing Address (if different)
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  14. Full Time Openings

  15. 0-11 Months(*)
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  16. 1 Year(*)
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  17. 2 Years(*)
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  18. 3 Years(*)
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  19. 4 & 5 Years(*)
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  20. Kindergarten(*)
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  21. School Age(*)
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  22. Total Number of Full Time Vacancies

  23. 23 months and younger(*)
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  24. 2 years and older(*)
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  25. Number of Rooms

  26. Infant and Toddler(*)
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  27. Preschool to Kindergarten(*)
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  28. Grades 1-6(*)
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  29. Grades 6-9(*)
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  30. Facility Information

  31. Number of diapering stations?(*)
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  32. Number of children's restrooms?(*)
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  33. Number of playgrounds?(*)
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  34. Number of Children Currently Enrolled

  35. 0-11 Months(*)
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  36. 1 Year(*)
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  37. 2 Years(*)
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  38. 3 Years(*)
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  39. 4 Years(*)
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  40. 5 Years (not in kindergarten)(*)
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  41. Kindergarten(*)
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  42. Grades 1-6(*)
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  43. Grades 6-9(*)
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  44. Monthly Rates

  45. Do you accept state child care subsidy?(*)
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  46. 0-11 Months(*)
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  47. 1 Year(*)
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  48. 2 Years(*)
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  49. 3 Years(*)
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  50. 4 Years(*)
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  51. 5 Years (not in kindergarten)(*)
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  52. Kindergarten- in school(*)
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  53. Kindergarten- out of school(*)
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  54. School Age- in school(*)
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  55. School Age- out of school(*)
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  56. If you need to update other information or have questions about this form, please contact our office at 801-355-4847 or 866-438-4847 - Monday through Thursday 7:30 AM - 6:00 PM(MST)