ATTACHMENT A PROGRAM PARTNER AGREEMENT.PDF
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ATTACHMENT A Program Partner Agreement Thank you for your interest in becoming a Jumpstart program partner for the coming year and beyond! This Agreement covers the essential aspects of the Jumpstart program partnership and requests information that is crucial to the success of the partnership and the Jumpstart program. We encourage you to work closely with Jumpstart program staff in your area to complete this form. If you have questions, please contact Amanda Gryzkewicz at 262.339.6614 or Amanda.gryzkewicz@jstart.org. Note: If you are unable to check “yes” for any of the items in this document, please do not sign at the end of the document until you have discussed these items with the Jumpstart site manager listed above. Date form is completed: ____________________________________ Name of Center/Location: Maricopa County Human Services Department Head Start Program Center/Location Address: 2150 S. Country Club Drive, Ste 7 Mesa AZ 85210 Center/Location Telephone:480-464-9669 Fax:480-655-1154 Name of Principal/Director: Alecia Jackson Name and title of person completing form: Denise Corvino, Child Development and Health Manager____ Please designate a staff person at your program to be the official liaison to the Jumpstart program (preferably Director or Education Coordinator): Name and title of liaison: Denise Corvino, Child Development and Health Manager Liaison’s contact information (best way to reach): corvinod@mail.maricopa.gov or 480-464-9669 x296 How many total children (birth to age 6) are served in your center? 20 each site How many children ages 36 to 59 months are served in your center? 20 each site The term of this Agreement shall commence on the date listed above and end at the completion of the 2016-2017 program year. Jumpstart depends on the strength of our partnerships with early childhood providers such as you to make our program, and our service to young children, a success. We deeply appreciate the time you are taking to complete this Agreement, and we look forward to working with you to make the Jumpstart program a reality at your center! Program Partner Agreement Page 1 of 12 Intranet>SMB>Program Partners Last updated on 07.07.16 ATTACHMENT A As with any partnership, we believe that the process, not just the piece of paper, ensures a strong relationship. Thank you for your continued communication and work with us to build that partnership. I. SCHOOL SUCCESS JUMPSTART WILL: 1) Recruit and train Corps members to provide language and literacy support to children in a low ratio environment with small group learning opportunities 2) Conduct two-hour Jumpstart sessions, twice a week, consisting of a group of Corps members and children, and a team leader providing guidance 3) Provide a research-based, developmentally appropriate curriculum that supports children’s development in oral language, books and print knowledge, and phonological awareness (key emergent or early literacy skills) for use during Jumpstart sessions 4) Provide site manager support for implementation of high quality Jumpstart sessions through ongoing observation and feedback with Jumpstart teams and communication with teachers and staff 5) Supplement educational materials and supplies, including core storybooks and manipulative items, to enhance and extend children’s learning during Jumpstart sessions 6) Provide two to six hours of Classroom Assistance Time by each Corps member weekly, to support children and teachers in the regular classroom setting THE CENTER WILL: 7) Designate at least one regular classroom per Jumpstart team in which at least 75% of enrolled children are 36 to 59 months of age at the start of the school year Yes AND 75% of enrolled children are from low-income families as defined by federal guidelines for reduced-cost meals. Yes Each classroom will host Jumpstart sessions and provide Jumpstart Corps members access to all children normally enrolled in these classrooms Yes Designated classroom #1_ Jefferson: 120 S. Jefferson Room 1, Mesa (480-472-8651) # of children in classroom #1 20 % of children in classroom #1 from low-income communities in 2015-2016 _100%____ % of children in classroom #1 that were between 36-59 months in 2015-2016 __100%__ Days and Hours of Classroom #1 (e.g. MWF 8:30-2:00) M-F 8am-2pm Name of Lead Teacher in Classroom #1 Stacy Nalick Designated classroom #2 _ Holmes: 948 S. Horne, K-Portable, Mesa (480-472-5584) # of children in classroom #2 20 % of children in classroom #2 from low-income communities in 2015-2016 __100%______ % of children in classroom #2 that were between 36-59 months in 2015-2016 _100%______ Days and Hours of Classroom #2 (e.g. MWF 8:30-2:00) _M-F 8am-2pm Name of Lead Teacher in Classroom #2 Carmen Lopez Please report demographic information to the best of your ability. If there are more than two designated Jumpstart classrooms, please write them in Section XI at the end of this document and be sure to include the same data points (% low-income and % within age range). Program Partner Agreement Page 2 of 12 Intranet>SMB>Program Partners Last updated on 07.07.16 ATTACHMENT A 8) Ensure that an adequate number of children will be enrolled in the classroom(s) selected to host Jumpstart sessions by the start of sessions, or early enough in the program year to allow late-enrolled children to participate in Jumpstart for a span of 120 calendar days, and that children will consistently be present during scheduled Jumpstart session times in order to allow Jumpstart to engage the anticipated number of children Yes 9) Anticipated number of children: _40 total____Work with Jumpstart to create and implement contingency plans, in the event that child enrollment or attendance during scheduled Jumpstart sessions does not allow Jumpstart to engage the desired number of children. Contingency plans may include, but are not limited to: moving a Jumpstart team to another preschool classroom, accommodating a pull-out session model that combines children from multiple classrooms, releasing Jumpstart from this agreement (if no reasonable options exist to allow Jumpstart access to the number of children required to fulfill related goals or maintain recommended Corps member: child ratios) Yes 10) Adhere to the following at all times Jumpstart Corps members or staff members are present: Provide supervision and accompaniment (direct physical presence) by licensed center teacher Yes Ensure that all licensing and operational policies are met Yes Retain liability for children, licensing, operational policies, and other regulations at all times Yes 11) Arrange to have a consistent licensed teacher, preferably the regular teacher(s) for the classroom hosting sessions, present and participating in the Jumpstart session (actively participating; supporting classroom and behavior management; directly supporting children with significant disabilities or significant behavioral challenges; acting as a “Jumpstart partner” for children as needed); Center and center teachers will be solely responsible for any classroom emergencies including without limitation, any child medical emergency, or behavior-related emergency, or other actions involving center children. Yes Teacher(s) supporting sessions: Jefferson: Stacy Nalick, Tara Brauch, Ana Uribe Holmes: Carmen Lopez, Ronak Odish, Lori Germano ___________________________________ 12) For dual-language programs or other programs supporting instruction and adult-child interactions in languages other than English, ensure that Jumpstart sessions are scheduled at a time/block when English is the dominant language of instruction for children. Please note: Jumpstart sessions are delivered in English. NA Yes 13) Allow Jumpstart to use books & general supplies in the classroom/center Yes 14) Provide snack for the Jumpstart session, if required by schedule/licensing Yes 15) Provide space for the Jumpstart team(s) to meet before/after Jumpstart sessions Yes 16) Provide storage space for the Jumpstart team(s) Yes 17) Ensure that teachers welcome individual Corps member participation in their classrooms for Classroom Assistance Time for up to six hours per week Yes II. FAMILY INVOLVEMENT JUMPSTART WILL: 1) Train and support Corps members to communicate and reinforce the Jumpstart-home learning connection with families of children in Jumpstart Program Partner Agreement Page 3 of 12 Intranet>SMB>Program Partners Last updated on 07.07.16 ATTACHMENT A 2) Provide families with information about the Jumpstart program, educational resources related to Jumpstart’s approach, and regular communication about their children’s participation in Jumpstart 3) Orient families to Jumpstart at the start of the program year 4) Support program partner efforts related to family outreach and involvement as appropriate, and consult with center staff on implementation of Jumpstart family activities THE CENTER WILL: 5) Connect Jumpstart with a family involvement coordinator (if applicable) at the center so that Jumpstart can: Coordinate our efforts with pre-existing family activities at your center Yes Consult them regarding our family activities (orientations, communication) Yes If yes, Name: Nancy Kessay Contact Info: KessayN@mail.maricopa.gov 6) Invite Jumpstart to participate in existing family events: Yes Names/dates of events: TBD 7) Assist Jumpstart in informing families that children will be participating in Jumpstart by distributing session information on Jumpstart’s behalf and speaking with families at your center Yes 8) Provide support, including translations (as per center’s capacity), to assist Corps members in communicating with families whose home language is not English Yes 9) Include a description of Jumpstart in a newsletter or mailing to families Yes 10) Allow Jumpstart to use the center’s logo on any communication to families Yes 11) Allow Jumpstart to have access to a portion of a bulletin board to post program information Yes ADDITIONAL INFORMATION: 12) What is the best way to reach out to families of children who will participate in Jumpstart sessions? How can Jumpstart work with your center in this effort? Handouts to be provided in each child’s cubby. 13) How could Jumpstart’s communication with families and other family involvement activities be integrated with those of your center? Monthly parent meetings or trainings. III. CHILD ASSESSMENT AND MEASURING IMPACT JUMPSTART WILL: 1) Request consent to collect and utilize information related to children’s language and literacy abilities and demographic data from children’s families, using Jumpstart’s standard Consent Form. 2) Collect information related to children’s language and literacy abilities reported by teachers using the Jumpstart School Success Checklist teacher rating form and/or administer the Test of Preschool Early Literacy (TOPEL). Center participation in one or both assessment methods will be determined by Jumpstart and communicated to center staff by the start of the program year. Jumpstart will only use Program Partner Agreement Page 4 of 12 Intranet>SMB>Program Partners Last updated on 07.07.16 ATTACHMENT A and report children’s scores in aggregate to better understand and represent the impact of our program. 3) Provide information and guidance to support the child assessment process: For centers selected to participate in the Jumpstart School Success Checklist process, Jumpstart will communicate timelines for Jumpstart School Success Checklist completion based on session start and end dates determined in partnership with the center. Jumpstart will provide guidance and support for center teachers to complete this process in a timely fashion twice per year; For centers selected to participate in the TOPEL process, Jumpstart will provide basic information about assessment tools, scheduling, and space needs. Jumpstart assessors will come to the center to collect language and literacy information about children who have parent/guardian consent during the two to three weeks prior to session and the two to three weeks after session concludes. 4) Provide the following point person for coordinating the child assessment process on Jumpstart’s behalf and work with Jumpstart staff to collect additional, important information to assess Jumpstart’s impact: Name/Title Amanda Gryzkewicz Phone/ext. 262.339.6614 5) Use information related to children’s demographic information and language and literacy abilities, as reported by teachers on the Jumpstart School Success Checklist or collected by Jumpstart using the TOPEL, to gauge the effectiveness of the Jumpstart program to continuously improve Jumpstart’s program model THE CENTER WILL: 6) Assist Jumpstart in obtaining Consent Forms authorizing Jumpstart to collect and utilize children’s demographic data and information related to children’s language and literacy abilities as reported by teachers and/or to administer the TOPEL by distributing and collecting forms on Jumpstart’s behalf Yes And work with Jumpstart to ensure Consent Forms related to assessment are completed and returned by all families of children in participating classrooms prior to teachers completing any Jumpstart School Success Checklists or Jumpstart assessors administering the TOPEL Yes 7) If selected to participate in the Jumpstart School Success Checklist process: Work with Jumpstart to arrange an orientation/training to this process for classroom teachers before teachers complete pre-session Jumpstart School Success Checklists Yes Ensure each teacher in a participating classroom completes the Jumpstart School Success Checklist process for children in their classroom Yes Ensure that Checklists are completed within the requested timeframes twice a year, during program start-up and wrap-up Yes 8) If selected to participate in the direct assessment process: Coordinate with Jumpstart site managers to schedule time for assessors to come in and collect language and literacy information about children who have parent/guardian consent during the two to three weeks prior to session and the two to three weeks after session concludes Yes Provide space in the back of the classroom, or another space where a licensed center staff member would be present, for assessments to occur Yes 9) Provide Jumpstart with consistent access to center level data, including but not limited to aggregate demographic data (not for individual children), or inform Jumpstart in writing if the center cannot Program Partner Agreement Page 5 of 12 Intranet>SMB>Program Partners Last updated on 07.07.16 ATTACHMENT A provide this information. This information is important for our program reporting and improvement and is not used to place a “value” or “weight” on specific centers or children Yes 10) Provide Jumpstart with consistent access to child level data for children with parental consent, including but not limited to available demographic data (i.e. gender, race, language, socio-economic status, date of birth), attendance data, and assessment data for individual children Yes 11) Provide the following point person for coordinating the child assessment process on the center’s behalf and work with Jumpstart staff to collect additional, important information to assess Jumpstart’s impact: Name/Title Stacy Nalick (Jefferson) Phone/ext. 480-472-8651 Carmen Lopez (Holmes) 480-472-5584 IV. CORPS MEMBER MANAGEMENT AND DEVELOPMENT JUMPSTART WILL: 1) Train Corps members to work effectively with young children, while encouraging them to choose career and service opportunities that positively impact early childhood education and their communities 2) Support improvement of Corps members’ classroom practice and interactions with children through ongoing observation and feedback 3) Model and reinforce developmentally appropriate practice and quality implementation of Jumpstart’s curriculum through ongoing coaching by site managers and team leaders 4) Engage Corps members in annual performance reviews based on interactions in the classroom and general participation in the Jumpstart program 5) Encourage Corps members to learn from classroom teachers THE CENTER WILL: 6) Encourage teachers to communicate regularly with the Jumpstart site manager, team leader or designated Corps member regarding classroom curriculum Yes 7) Ensure that Corps members are not participating in or asked to participate in activities prohibited by AmeriCorps while they are serving at the center Yes The following is a list of AmeriCorps prohibited activities. Corps members cannot participate in these activities while participating in Jumpstart activities, wearing the Jumpstart uniform (Jumpstart t-shirt or sweatshirt with appropriate logos), or earning hours. Attempting to influence legislation. Organizing or engaging in protests, petitions, boycotts, or strikes. Assisting, promoting or deterring union organizing. Providing abortion services or referrals for receipt of such services. Impairing existing contracts for services or collective bargaining agreements. Engaging in partisan political activities or other activities designed to influence the outcome of an election to any public office. Participating in, or endorsing, events or activities that are likely to include advocacy for or against political parties, political platforms, political candidates, proposed legislation, or elected officials. Engaging in religious instruction; conducting worship services; providing instruction as part of a program that includes mandatory religious instruction or worship; constructing Program Partner Agreement Page 6 of 12 Intranet>SMB>Program Partners Last updated on 07.07.16 ATTACHMENT A or operating facilities devoted to religious instruction or worship; maintaining facilities primarily or inherently devoted to religious instruction or worship; or engaging in any form of religious proselytization. Providing a direct benefit to a for-profit entity; a labor union; a partisan political organization; a nonprofit organization that fails to comply with the restrictions contained in section 501(c)(3) of the Internal Revenue Code of 1986 related to engaging in political activities or substantial amount of lobbying except that nothing in these provisions shall be construed to prevent participants from engaging in advocacy activities undertaken at their own initiative; or an organization engaged in the religious activities described in the preceding sub-clause, unless Grant funds are not used to support the religious activities. Conducting, initiating or participating in voter registration drives. In addition, Corporation funds may not be used to conduct a voter registration drive. Nonduplication. Corporation assistance may not be used to duplicate an activity that is already available in the locality of a program. And, unless the requirements of nondisplacement below are met, Corporation assistance will not be provided to a private nonprofit entity to conduct activities that are the same or substantially equivalent to activities provided by a State or local government agency in which such entity resides. Nondisplacement. (1) An employer may not displace an employee or position, including partial displacement such as reduction in hours, wages, or employment benefits, as a result of the use by such employer of a participant in a program receiving Corporation assistance. (2) An organization may not displace a volunteer by using a member. (3) A service opportunity may not be created under the program that will infringe in any manner on the promotional opportunity of an employed individual. (4) The member may not perform any services or duties or engage in activities that would otherwise be performed by an employee as part of the assigned duties of such employee. (5) The member may not perform any services or duties, or engage in activities that: will supplant the hiring of employed workers; or are services, duties, or activities with respect to which an individual has recall rights pursuant to a collective bargaining agreement or applicable personnel procedures. (6) The member may not perform services or duties that have been performed by or were assigned to any: Presently employed worker; Employee who recently resigned or was discharged; Employee who is subject to a reduction in force or who has recall rights pursuant to a collective bargaining agreement or applicable personnel procedures; Employee who is on leave (terminal, temporary, vacation, emergency, or sick); Employee who is on strike or who is being locked out. Such other activities as CNCS may prohibit. The center shall adhere to the following restrictions on Corps member service: 8) NOT hire Corps members as paid employees during their Jumpstart term of service Yes 9) NOT allow Corps members to serve in the place of paid employees at your center, for example serving as regular or substitute teachers Yes 10) NOT allow Corps members to serve children without the supervision and accompaniment (physical presence) of a licensed teacher who has been cleared for access to children through the center’s criminal history check process OR is otherwise permitted access to vulnerable populations by the nature of his or her profession as an educator Yes ADDITIONAL INFORMATION: Program Partner Agreement Page 7 of 12 Intranet>SMB>Program Partners Last updated on 07.07.16 ATTACHMENT A 11) Please comment on the role of teachers in your center. What do you want Jumpstart and our Corps members to know about working with teachers? The program's goal is to promote children's social, emotional, cognitive and physical development, so they are prepared for future success in school. This educational program recognizes that children grow in the context of their family and culture. Our staff work collaboratively to ensure high-quality early education; they are professionals and look forward to working with Jumpstart Corp members. V. ADMINISTRATIVE POLICIES & PROCEDURES JUMPSTART WILL: 1) Streamline administrative procedures whenever possible by supporting, rather than duplicating, the policies and procedures used by centers. 2) Adhere to all required administrative tasks and procedures as requested. 3) Initiate criminal history checks of AmeriCorps members before they are allowed to begin classroom service. AmeriCorps members will be allowed to serve with Jumpstart once they have successfully initiated all components of a criminal history check in accordance with Jumpstart’s policy and applicable state regulation(s). These checks include a National Sex Offender Public Website check, state(s) of service and of residence through the AmeriCorps designated state repositories, and a FBI fingerprint check. 4) Initiate criminal history checks of Jumpstart members before they are allowed to begin classroom service. Jumpstart members will be allowed to serve with Jumpstart once they have successfully initiated all components of a criminal history check in accordance with Jumpstart’s policy and applicable state regulation(s). These checks include a National Sex Offender Public Website check and a FBI fingerprint check. THE CENTER WILL: 5) Provide a current certificate of insurance to ensure proper coverage and liability insurance is in place Yes 6) Provide an orientation for Jumpstart Corps members to center policies and procedures relevant to the work of Jumpstart, such as classroom rules, sign in/sign out procedures, abuse and neglect reporting procedures, etc. Yes 7) Provide in-kind valuation for classroom space used by Jumpstart teams using Jumpstart’s Program Partner In-Kind Form by end of Jumpstart sessions. NA Yes 8) Assist Jumpstart in meeting local medical/health requirements for Corps members (e.g. TB tests, etc.) by sharing center medical/health policies and resources used by your center to meet these requirements with Jumpstart. Yes 9) NOT allow Corps members to serve children without the supervision and accompaniment (physical presence) of a licensed teacher who has been cleared for access to children through the center’s criminal history check process OR is otherwise permitted access to vulnerable populations by the nature of his or her profession as an educator (additional accompaniment conditions noted in section VI, 8). Yes ADDITIONAL INFORMATION: Program Partner Agreement Page 8 of 12 Intranet>SMB>Program Partners Last updated on 07.07.16 ATTACHMENT A 10) Please complete the table below with all of the criminal history checks you require of volunteers. Be sure to include all current requirements for Corps members to serve at your location. If your center has no criminal history check requirements, please check here: None Name of Check Source of Check Timing Requirement Price of Check Who is responsible of Check for conducting the check? Central Registry AZ Dept. Health Must be submitted Free Jumpstart—results Svcs prior to starting in (approval letter) classroom to be submitted to Maricopa County Early Education Div Fingerprint Dept. of Public Must be submitted $65.00 Vol Jumpstart—results Clearance Card Safety prior to starting in (receipt letter and classroom copy of clearance card, front and back) to be submitted to Maricopa County Early Education Div Affidavits DHS (2) for each Must be submitted Free Jumpstart of the above prior to starting in classroom VI. CHILD ABUSE PREVENTION AND PROTECTION POLICY JUMPSTART WILL: 1) Provide Corps members with training and coordinate center staff to provide an orientation in order to: Provide information on recognizing signs of child abuse Review Jumpstart’s child abuse prevention and protection policies Orient Corps members to the center’s child abuse reporting procedures 2) Provide center staff with the most current version of Jumpstart’s Child Abuse Prevention and Protection Policy, including notification of any updates or revisions. This document includes the policy we communicate to Corps members for steps to take in the event of suspected abuse or neglect and prohibited and permissible activities for Corps members engaging with children. 3) Prohibit Jumpstart staff, Corps members and non-Corps member volunteers from being left unaccompanied with children and ensure that Corps members adhere to Jumpstart’s prohibited and allowable activities lists 4) In any instance where a Jumpstart Corps member, staff member or non-Corps member volunteer suspects that a child is being abused or neglected, follow Jumpstart’s Child Abuse Prevention and Protection Policy and the procedures of the program partner to comply with all state and local regulations regarding reporting abuse or neglect; work with center staff to navigate any policy conflicts, as needed Program Partner Agreement Page 9 of 12 Intranet>SMB>Program Partners Last updated on 07.07.16 ATTACHMENT A 5) Discuss with Corps members the importance of respecting confidentiality guidelines in all work with children and families, and require all Corps members to sign an assurance of confidentiality form THE CENTER WILL: 6) Provide Jumpstart with a copy of center’s child abuse and neglect reporting policy Yes 7) Orient Corps members to the center’s child abuse reporting procedures (to be followed in conjunction with Jumpstart’s Child Abuse Prevention and Protection Policy) Yes 8) Ensure that Jumpstart staff, Corps members and non-Corps member volunteers are accompanied by (in the physical presence of) teachers or other center staff who have been cleared for access to children through the center’s criminal history check process OR are otherwise permitted access to vulnerable populations by the nature of their profession as educators at all times Jumpstart operates. This may require additional documentation to ensure that accompaniment occurred. Yes During program audits by select funders, Jumpstart may be asked to obtain documentation of the center’s criminal history check procedures, definitions of “educators” or others roles permitted access to children by the nature of their professions, and/or documentation of history check clearance. Do you agree to make these available to Jumpstart’s auditors if requested? Yes 9) Abide by the most recent version of Jumpstart’s Child Abuse Prevention and Protection Policy, agree to support Corps members’ efforts to follow this policy, and agree to work with Jumpstart to navigate any policy conflicts (as needed). Yes VII. PUBLIC RELATIONS JUMPSTART WILL: 1) Obtain media releases, included in Consent Forms, for all children participating in Jumpstart 2) Communicate with center staff to coordinate planning and scheduling of occasional site visits or media outreach THE CENTER WILL: 3) Be willing to take part in an occasional discussion with Jumpstart supporters Yes 4) Be willing to help schedule occasional site visits to the center for Jumpstart supporters Yes 5) Allow Jumpstart to videotape or photograph the site, staff, and/or children for the purposes of promoting the program, provided media releases have been obtained Yes VIII. JUMPSTART-PROGRAM PARTNER RELATIONSHIP JUMPSTART WILL: 1) Be proactive and responsive in communicating with the center 2) Ask program partner for formal feedback twice a year 3) Use feedback from center liaison, teachers, and other staff in continually seeking to improve the quality of the partnership and services provided THE CENTER WILL: 4) Provide feedback to Jumpstart at the middle and end of the school year, through completion of the Program Partner Feedback Form and/or other formats Yes Program Partner Agreement Page 10 of 12 Intranet>SMB>Program Partners Last updated on 07.07.16 ATTACHMENT A IX. DISCLAIMER AND LIABILITY LIMITATION Except as expressly set forth in this Agreement, each service provided by Jumpstart under this agreement is provided “as is” and “as available,” with no representations or warranties of any kind. In no event shall Jumpstart, Corps members, the Center or their officers, directors, employees or agents be liable to the other on any basis arising from or related to this Agreement for any special, indirect, incidental or consequential damages. X. PROGRAM PARTNER COMMITMENT Our center is a registered 501(c)(3) non-profit organization Yes By signing below, we signify our commitment to a partnership between Jumpstart and Maricopa County Early Education Division/Birth to Five Program (Head Start) (program partner name), including all information and terms outlined above. Signature of Center Representative & Title Printed Name Date Signature of Jumpstart Representative & Title Printed Name Date Reminder: If you are unable to check “yes” for any of the items in this document, please do not sign here until you have discussed these items with the Jumpstart site manager listed above. Program Partner Agreement Page 11 of 12 Intranet>SMB>Program Partners Last updated on 07.07.16 ATTACHMENT A XI. CLASSROOM INFORMATION Note to Program Partners: Jumpstart collects the following information on an annual basis to help us plan and make decisions regarding our team placement and impact in the community. If you are unable or unwilling to provide this information, please notify Jumpstart in writing, as outlined in the Program Partner Agreement. Please complete the following grid for all classrooms at your center in which 75% of enrolled children are 36 to 59 months of age and 75% of children are from low-income families as defined by federal guidelines for reduced-cost meals. Please include classrooms that are being served by Jumpstart as well as those that are not. This information will help Jumpstart identify potential additional classrooms we might serve in the future. Name/Number of Jumpstart If not a Jumpstart Number of % of children in % of children in Days and Hours of Name of Lead Teacher Classroom (e.g. Room 1, Classroom classroom, would it Children in classroom that were classroom from low- Classroom Little Leaders) (y = yes/ n = be potential for the Classroom between 36-59 income families in 2015- (e.g. MWF 8:30-2:00) no) future? (y or n) (approx.) months in 2015-2016 2016 Jefferson Y 20 100% 100% M-F 8a-2p Stacy Nalick Holmes y 20 100% 100% M-F 8a-2p Carmen Lopez See site list TBD ±85-90% Jumpstart site: ___________________________ Center name:_____________________________________ Date completed: ___________________________ Program Partner Agreement Page 12 of 12 Intranet>SMB>Program Partners Last updated on 07.07.16