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ELSSA Membership Application
Please add your details below, and we will contact you to finalize the application process. Thank you!
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* Indicates required question
Your Full Name
*
Your answer
Your Program's Name
*
Your answer
Program's Legal Name (if different)
Your answer
Email Address
*
Your answer
Program Address
*
Your answer
County
*
Orange
Brevard
Seminole
Osceola
Other:
Is your program a Family Child Care Home or Child Care Center?
*
Family Child Care Home
Child Care Center
How long have you operated your program?
*
Less than 1 year
1-2 Years
3-4 Years
4-6 Years
6+ Years
What is your race?
*
White
Black/African American
Asian
Native American/Alaskan Native
Hawaiian Native/Other Pacific Islander
Two or More
Are you of Hispanic or Latino origin?
*
Yes
No
What is your preferred spoken/written language?
*
English
Spanish
Other
What is your business structure?
*
Sole Proprietorship (your business assets and liabilities are not separate from your personal)
Limited Partnership or Limited Liability Partnership
LLC
C Corp
S Corp
Date of your last CLASS assessment:
*
MM
/
DD
/
YYYY
Aggregate CLASS Score
*
Your answer
What is your current program enrollment?
*
Your answer
What is your ideal program enrollment?
*
Your answer
Do you currently use Child Care Management Software (like Procare, KidKare, Brightwheel)?
*
Yes
No
Do you have access to any of the following pieces of technology?
*
Computer/laptop
Touch screen mobile phone
Tablet
None
Required
Internet Access:
*
Cable
Dial-up
Other
None
How is your experience with your Internet Service Provider?
*
My internet barely works
I often have struggles with my internet connection
I sometimes have struggles with my internet connection
My internet connection works well most of the time
My internet connection is excellent
Which ELSSA services are of interest to you?
Enrollment Marketing
Staff Recruitment
Child Care Management Software
Bookkeeping
Financial Reporting
Payroll & Benefits Management
HR/Legal Support
Accreditation Coaching
Thank you for your interest! We will be in touch shortly to finalize the application process.
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