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Application

Program Information
* Center Name:
 
* Program Type:
Please check all that apply





* Number of Staff:  
* Number of Children Served:  
* Ages Served:  
* Program County:  
* Address:
 
* City:
 
State:
 
* Zip:
 
Primary Contact Information
* First Name:
 
* Last Name:
 
* Job Title:
 
* Email:    
* Direct Phone:  
Alternate Phone:
Are you enrolled in ABC Quality?:
Do you have a current, valid license or registration?:
Have you ever participated in the SC Program for Infant/Toddler Care?:
Does your program have the Breastfeeding Friendly Child Care designation?:
Reason(s) for applying - tell us why you are interested in participating in this program:
Number of Classrooms:
* Under 12 months old
 
* 12-24 months old
 
* 24-36 months old
 
* 3 to 5 years old
 

Selecting a Well-being Committee - Please Check Boxes to Confirm You Understand
* All checkboxes in this section are required
 
Please begin considering the individuals who will be on your Well-being Committee. The expectation is that your committee members meet together with the Well-being Coach at least 4 times over the year, but as often as monthly. A crucial meeting is at the beginning of the project to select well-being goals. After the initial meeting the committee can decide how frequently it meets and when the meetings will take place during the workday. In order to receive BWCW services, the Director must agree to release Well-Being Committee members from their classroom responsibilities at agreed upon Well-Being Committee meeting times (typically 30 minutes)
The role of the committee is to share ideas and develop strategies to help their program achieve their well-being goals. The Well-being Coach will communicate regularly with the committee to share opportunities and resources. The Well-being Coach will support your committee all along the way!
Your committee can include as many individuals as you’d like and we ask that you have a minimum of three. When considering who you’d like on your well-being committee, think about individuals in your program who are already engaged in fitness, health or well-being actives. You’ll want an enthusiastic committee comprised of individuals who are fun, energetic and encouraging.
We realize that everyone’s time is limited so rest assured that the work of this committee will not be overwhelming and everyone’s role can be adapted as needed to allow for participation.
Program Participation as a Whole - Please Check Boxes to Confirm You Understand
* All checkboxes in this section are required
 
Well-being Coach will visit monthly (or more) at agreed upon times
Programs must allow evaluator to visit at the start and end of the project to conduct observations, if selected.
  • We are working with researchers at MUSC to collect observation data using the CHILD Assessment to help us measure the impact of the Be Well Care Well project.
  • All data collected will be kept confidential and only be used to evaluate the project for project success and areas of improvement.
Staff will complete a group of questionnaires at the start and end of the project.
  • We are working with researchers at MUSC to collect data from participants that will help us measure the impact of the Be Well Care Well project. Individuals will be offered a small incentive for completing questionnaires at the start and end of the project.
A commitment to embracing well-being through fun and informative activities!

Type your name below to acknowledge you’ve read the Well-Being Committee description and expectations:

 
* Director Name

 
* Date
* I am ready to identify my Well-being Committee at this time  
Please finalize your application by clicking the Submit Application button below.
  
Questions? Email us at info@scpitc.org