Child Care Licensing Feedback Form
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What is your license number? *
What type of visit did you have? *
Were you present at the time of the inspection? *
Who is your current Licensing Specialist  *
Required
Licensing Specialist's name, if not listed above
To what extent did you understand the violations cited on your Report of Inspection?
Clear selection
How satisfied were you with the technical assistance your Licensing Specialist provided on the following
N/A I did not need/want technical assistance
Very Dissatisfied
Dissatisfied
Satisfied
Very Satisfied
Compliance with Child Care Rules and Regulations
Achieving a Level 2 in Colorado Shines
Information on how to access the Professional Development Information System (PDIS)
Accessing available Child Care Grants
Clear selection
To what extent did you feel like your questions/concerns were addressed during your most recent licensing visit?
Clear selection
Check the following to indicate what additional information or assistance you would like to be successful in the HUB.
Do you have any additional questions or need further clarification on any of the following:
Clear selection
Phone number to reach you if you have additional questions or need further clarification *
Would you like to speak with a Licensing Supervisor regarding a recent inspection?
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If you answered YES to the above question that  you want to speak to a supervisor, please provide your name and phone number so we may contact you.
Additional Comments
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