2025-2026 Application for Community Providers to become a Partnering Agency for the WCSD 4K Program
If this application is accepted, a 4K School-Community Partnering Agreement will need to be signed by authorized staff from both parties (center and WCSD).
Email *
Center Name (as appears on State License) *
State of Wisconsin License Number (and/or other accreditation information) *
Center Address *
Center City, State & Zip Code *
Phone Number at Center *
Fax Number at Center
Contact Person at Center *
Email for Contact Person *
Person Authorized to Make Commitments for Center (if different)
Authorized Person's Phone Number
Authorized Person's Email
Do you lease or own the child care facility? *
Number of teachers at your site who hold DPI licenses: *
Teachers of 4K students must hold a prekindergarten or kindergarten license. Number of teachers at your site who hold a DPI license which allows them to teach 4K: *
The morning session will likely be approx. 7:40-10:20 Monday through Friday.  The afternoon session will likely be approx. 11:35-2:15 Monday through Friday.  Are you able to offer AM, PM or both? *
Number of classrooms available for 4K *
Maximum number of 4 year-olds center can accommodate per classroom: *
Number of reimbursement-eligible seats you are proposing to make available to WCSD: *
Are you able to offer wrap-around care at your center? *
What are the wrap-around care hours?  For what purpose (daycare, religious education, etc.)?  Please explain offerings.
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Waunakee Community School District. Report Abuse
Google Forms