Service Plan Application
In order to be considered for SCPITC services, you must complete all sections of this application.
Section I: Program Information
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Is there an Owner, Board of Trustees, offsite agency, or other governing body in addition to the onsite program director?
Yes
No
* Required
Site/Program Information
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Center Name:
* You must enter center name
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SC Endeavors Organization ID #:
* Required
Only Numbers allowed for SC Endeavors Organization ID
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SC DSS License #:
* Required
Only Numbers allowed for SC DSS License Number
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Program Type:
Please Select
Center
Family
Group
* Required
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Program County:
Please Select
Abbeville
Aiken
Allendale
Anderson
Bamberg
Barnwell
Beaufort
Berkeley
Calhoun
Charleston
Cherokee
Chester
Chesterfield
Clarendon
Colleton
Darlington
Dillon
Dorchester
Edgefield
Fairfield
Florence
Georgetown
Greenville
Greenwood
Hampton
Horry
Jasper
Kershaw
Lancaster
Laurens
Lee
Lexington
Marion
Marlboro
Mccormick
Newberry
Oconee
Orangeburg
Pickens
Richland
Saluda
Spartanburg
Sumter
Union
Williamsburg
York
* Required
Physical Address:
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Address:
* Required
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City:
* Required
State:
* Required
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Zip:
* Required
Check if mailing address is different:
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Main Phone:
* Required
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FEIN:
* Required
Primary Contact Information
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First Name:
* Required
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Last Name:
* Required
Direct Phone:
Alternate Phone:
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Job Title:
* Required
Fax:
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Email:
* Required
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Number of Children Served:
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Under 12 months old
* Required
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12-24 months old
* Required
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24-36 months old
* Required
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3 to 5 years old
* Required
Caregiver and Classroom Information:
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Number of Caregivers working with
children birth to 36 months
* Required
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Number of Caregivers working with
children 3 to 5 years old
* Required
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Number of classrooms for children birth-36 months
* Required
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Number of classrooms for children 3 to 5 years old
* Required
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Number of children birth to 3 years old receiving SC Vouchers
* Required
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Number of children 3 to 5 years old receiving SC Vouchers
* Required
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DSS Licensing Capacity
* Required
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Please tell us how you heard about SCPITC:
State/regional/local conference
A local training
CCR&R
ABC Quality Assessor
Other:
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What is your current ABC Quality Level? (Select one)
A
A+
Pending
B
B+
Not yet enrolled
C
* Required
Who is your ABC Assessor?
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What is your current annual budget allocation for staff professional development?
* Required
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Have you received any Federal, State, or County subsidy to support staff professional development?
Yes
No
* Required
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Will your program pay the staff to attend training sessions that occur after work hours?
Yes
No
* Required
Section II: Professional Growth Incentives Acknowledgement
These incentives are available only to programs that choose to enroll in the full SCPITC Service Plan (approximately 100 hours of training and coaching):
Classroom Materials Grant
Centers participating in the SCPITC Service Plan will receive a $600 grant to purchase materials for the infant/toddler classrooms. Family Child Care Homes will receive $250 per program. The Infant/Toddler Specialist must approve materials purchased with the grant funds. These funds cannot be used for start-up costs, staff salary, consumables (e.g., paper, paint, etc.) or any construction or improvements of buildings.
Certificates of Participation
Center-based caregivers, family child care providers, and administrators who participate in the SCPITC Service Plan and attend a minimum of 12 hours of training will be eligible to receive a Certificate of Participation at the completion of the approved plan.
Individual Growth Incentives
Participants are eligible for only one of the incentives listed below. To be eligible for either incentive, individual participants must:
work at a program that is enrolled in ABC Quality
not miss more than two of the monthly trainings
remain at the program for at least six months following training
work with children ages birth to 36 months for at least 20 hours per week (Participants who are hired after the start of the training may qualify for a partial incentive if they begin participating before the midpoint of the training schedule, and do not miss more than one training session.)
Stipend Eligibility ($175)
Each qualifying administrator and teacher who participates in a training plan in which the majority of training hours are held during unpaid, non-work hours (evenings and weekends) will be eligible to receive $175. If program staff are paid by the child care program to attend trainings after work, the staff are not eligible to receive the individual stipend.
Resource Grants (applies to center-based programs only)
Programs that participate in an approved SCPITC Service Plan in which the majority of training hours are held during paid work hours will be eligible for an additional resource grant. The total amount of the resource grant will be calculated at $175 per qualifying participant.
DSS Training Hours
Each training session will provide 2 hours of DSS training in various topic areas so that participants who attend all trainings will receive credit for their required DSS training hours. Participants must sign the roster at each training session in order to receive credit.
BY typing my name and the date below, I certify that I have read and understand the eligibility requirements to receive Professional Growth Incentives from SCPITC, and that this information has been shared with my staff who will participate in the SCPITC Service Plan.
* You must print your name
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Director Name
* You must enter date
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Date
Section III: Program Director Agreement
In order to maximize the impact of the funds set aside to support the SCPITC, these resources must be allocated to those programs that are in the best position to benefit from the services offered. Please read the statements below carefully. Checking the boxes certifies that you understand and are making the commitment to meet the following requirements:
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All checkboxes in this section are required
* Please check all the checkboxes in this section
Together with the Infant/Toddler Specialist (ITS) and my program staff, I will create an action plan to implement changes in program policies, procedures, and practices to effect desired program improvements.
I will work with the ITS to develop a mutually agreed upon meeting schedule.
I will arrange staff participation by providing release time away from classroom responsibilities during work hours and/or after hours in the evening or on weekends as needed for the determined service plan.
I will participate in all training and actively engage in any planned technical assistance activities.
I will hold staff and myself accountable for putting into action the information we gather at meetings and trainings and from the ITS during technical assistance visits.
I understand that at least 80% of participating staff must be present at any training. If fewer than 80% are able to attend the training, I will notify the ITS ahead of time, and understand the training may be rescheduled.
I understand that when participating in the Service Plan, a lapse in training attendance of more than 30 days may result in termination of services.
I will provide opportunities for the ITS to observe and work as needed based on the agreed-upon service plan with the program staff in the infant/toddler classroom(s).
I confirm that our program is currently enrolled in the ABC Quality Program, and agree to stay an active part of ABC at least for at least a year following our SCPITC Service Plan.
I understand there will be no children permitted at training sessions.
I agree to attend at least one Director Network Meeting in my area provided by SCPITC.
I will be responsible for collecting photo releases from family and staff allowing SCPITC to use photographs for training and outreach purposes. I will notify the ITS if there are any individuals who do not release permission to be photographed for these purposes.
I have read and understand the above statements.
* You must print your name
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Program Director/Primary Contact Name
* You must enter date
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Date
Section IV: Statement of Commitment
The impact of the SCPITC services is directly linked to the commitment and participation of the program administrators. During your partnership with SCPITC, it is important that administrative staff fully participate in all sessions to support, guide and engage staff in implementing recommended changes for program improvement. Please list your administrative staff by name and title and indicate who will be participating in SCPITC services.
Name
Title
Participating?
To help us better assess the level of services that will best meet the needs of your program, please answer the questions below.
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1. What are the strengths of your infant/toddler program?
* Required
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2. What are the weaknesses of your infant/toddler program?
* Required
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3. What are the specific goals have for your program and in what way do you anticipate the SCPITC Infant/Toddler Specialists can help you achieve those goals?
* Required
Section V: Most Recent ABC Quality Assessment Report
Be sure to upload your most recent ABC Quality Assessment Report with your application. If you are unable to locate the report, please type your name and the date below to indicate that you give approval for your ABC Quality Assessor to send your ABC report to the Infant/Toddler Specialist. The information from your most recent ABC Quality assessment report will be used to help prioritize the services offered by SCPITC. We will work with you to help improve your ABC Quality score.
ABC Quality Assessment Report:
I authorize the ABC Quality Program to submit my latest ABC Quality assessment report to SCPITC with the understanding that the information included in the report will only be used to support the training and technical assistance provided by the Infant/Toddler Specialist assigned to work with my program and me.
* You must print your name
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Name/Title
* You must enter date
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Date
Please finalize your application by clicking the Submit Application button below.
Questions? Email us at info@scpitc.org