June, 2003

Ellen S. Peisner-Feinberg, Ph.D.and the More at Four Evaluation Team

North Carolina More at Four Pre-kindergarten Program:

Year 1 (January - June 2002)

Child and Program Characteristics of the

Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program 1

© June 2003 by Ellen Peisner-FeinbergFPG Child Development InstituteUniversity of North Carolina at Chapel Hill

This report was written by Ellen Peisner-Feinberg. I wish to acknowledge the members of our More at Four Evaluation Team who assisted with this phase of the research: Kathleen Bernier, Donna Bryant, Kathryn Carrier, K.C. Elander, Meghan Herstine, Cathy Maris, Kelly Maxwell, Jessica Rothstein, and Satsuki Scoville. Thanks are offered for assistance with the programming and analysis of these data to: Anne Buu, David Best, David Gardner, Steve Magers, Rita Slater, and Wei Jin. Thanks also to Satsuki Scoville for the report design. We appreciate the efforts of numerous individuals at the More at Four programs across the state who provided these data and offer them our thanks.

Suggested citation: Peisner-Feinberg, E. S. (2003). Child and Program Characteristics of the North CarolinaMore at Four Pre-kindergarten Program: Year 1 (January - June, 2002). Chapel Hill, NC: FPG Child Development Institute.

This research was funded by the NC More at Four Pre-kindergarten Program, NC Department of Health and Human Services and Governor’s Offi ce, as part of the statewide evaluation of the NC More at Four Pre-kindergarten Program.

For more information about the Evaluation of the North Carolina More at Four Pre-kindergarten Program, visit the web site at www.fpg.unc.edu/~mafeval, or email mafeval@unc.edu.

500 copies of this document were printed at a cost of $1277.00, or $2.55 each.

Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program | 1

Overview of the More at Four ProgramThe North Carolina More at Four Pre-kindergarten Program is a state-funded initiative for at-risk 4-year-olds, designed to help them be more successful when they enter elementary school. More at Four is based on the premise that all More at Four is based on the premise that all More at Fourchildren can learn if given the opportunity, but at-risk children have not been given the same level of opportunity. The focus of this program is on children who have never been served in a pre-kindergarten program and/or children who have been “underserved” (those who are eligible for, but not receiving fi nancial assistance or who are in below-standard care). It is estimated that there are approximately 40,000 at-risk 4-year-olds in NC, with about 10,000 of these children being unserved and even more underserved.

The North Carolina More at Four Pre-kindergarten Program was initiated in late 2001, and sites began serving children as early as January 2002. More at Four provides classroom-based educational programs at a variety of sites designated by the local administration within each county or region. Children are selected for participation in More at Four based on risk status. More at Four based on risk status. More at FourThe programs are administered at the county or region level, and must include collaboration among the local school system(s), the local Smart Start partnership, and other interested members of the early childhood community (e.g., Head Start, child care providers, resource and referral agencies). More at Four classrooms operate in a More at Four classrooms operate in a More at Fourvariety of settings, including public schools, Head Start, and community child care centers (both for-profi t and nonprofi t). The programs operate on a school calendar basis for 6 to 6-1/2 hours/day and 180 days/year. The programs are intended to provide a high quality, comprehensive educational program for children, and must meet a variety of program guidelines and standards around curriculum, training and education levels for teachers and directors, class size and ratios, NC star-license ratings of 4 or 5, and other program services provided. Children may be enrolled in classrooms serving More at Four children More at Four children More at Fourexclusively or in classrooms blended with other programs.

In the fi rst year, applications were submitted by individual counties or regions (groups of counties) for state More at Four funds. Applications could More at Four funds. Applications could More at Fourbe submitted on two different tracks. The Fast Track applications were due in December for funding/program services starting in January, while Standard Track applications were due in January for funding/program services starting in March. The applications were reviewed by the state More at Four Offi ce and 28 were approved More at Four Offi ce and 28 were approved More at Fourfor funding (12 Fast Track and 16 Standard Track). Of the 28 grantees approved, 26 served children in the fi rst year.

2 | More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program 3

Overview of the Statewide Evaluation of the More at Four ProgramThe FPG Child Development Institute is conducting the statewide evaluation of the More at Four program. The evaluation is designed at Four program. The evaluation is designed at Fourto provide information that can be used for determining program effectiveness for children (accountability), program improvement (strengths/weaknesses, suggested areas for technical assistance), and decision-making for future activities and funding. The overall evaluation will address questions about who is being served by the More at Four program, the characteristics and More at Four program, the characteristics and More at Fourquality of the services provided, the satisfaction of families with the program, the outcomes of children attending these programs, the factors that are associated with better outcomes for children, and the factors that have enhanced or impeded the implementation of More at Four.

The current report provides information about the characteristics of the programs providing services and the children served during the fi rst year of operation (Spring 2002), based on data gathered from each program in operation.

Child- and Program-Specifi c Reporting FormThe evaluation team designed report forms for gathering information from each grantee in May, 2002, to report on their program services for the fi rst year (See Appendices A and B for report forms and instructions). In addition to serving a monitoring purpose for the Governor’s More at Four Offi ce, the information reported was at Four Offi ce, the information reported was at Fouranalyzed to provide evaluation information about the characteristics of the overall More at Four Program and the extent to which it was meeting the program guidelines and serving its intended purpose. The forms were created as PDF fi les, and could be completed either on the computer or by hand. Information for the fi rst year was gathered in one report, with some information reported monthly as appropriate (e.g., children

enrolled, attendance). Grantees provided information only for the months they were in operation during Year 1. Information was gathered at four levels:

u Contract (agency information, allocated slots)

u Site (site information, director/principal name, education, and certifi cations/credentials, service dates, operation days, teacher workdays, slots allocated)

u Classroom (classroom information, service dates, hours of operation, class size, slots allocated, lead and assistant teacher education, certifi cations/credentials, and entry/exit dates)

u Child (individual child information, date of birth, demographic characteristics, level of More at Four risk criteria, More at Four risk criteria, More at Four More at Fourservice priority status, previous child care service, household composition, entry/exit dates, monthly attendance, and information on disabilities)

ProcedureThe evaluation team sent report forms and accompanying instructions to all contract administrators or designated program contacts for the 26 programs operating in the fi rst year (Spring 2002). While the contract administrator was responsible for submitting the forms, they could enlist the assistance of site directors and/or teachers as needed to provide the necessary information and/or to assist with the completion of the forms. Each grantee utilized the procedures that worked best for them for completing the report forms.

The evaluation team received information back from all 26 programs. The team provided technical assistance to help grantees understand the form content, as requested. In addition, the evaluation team followed up on missing or inconsistent information to the extent possible by contacting the contract administrator or program contact responsible for submitting the forms.

2 More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program | 3

Key FindingsSome key research questions and fi ndings regarding program services and child characteristics are highlighted below. Overall, these fi ndings suggest that the More at Fourprograms operating in Year 1 served a diverse group of children in a wide array of settings. In general, the individual sites were meeting many of the program guidelines, although there was some variation across sites. It is important to note that this initial year of operation was characterized by a rapid start-up and short program year, beginning in the middle of the typical school year, which may have affected the number of children able to be served as well as the extent of services.

How many children were served in the More at Four Program?n Overall, more slots were allocated for the More at Four Program than were fi lled. This was true for most individual counties/regions, as well as for the state overall. The total number of children served in the fi rst year was 1244, representing 1234 slots that were fi lled (due to some turnover on the part of children). The number of slots allocated each month was greater than the number of children served that month. The total slots allocated ranged from 803 to 1479 per month, while the total number of children served ranged from 318 to 1181 per month. The discrepancies between allocated and fi lled slots lessened over time, from about 40% of the slots fi lled in January to about 87% fi lled in May.

Were the children served by the More at Four Program meeting the program guidelines in terms of risk factor status and service priority status?

n In general, programs were serving the intended population based on certain risk factors. In particular, the majority of children were designated at risk (scores of level 1 or 2) on the factors of family income and parental employment, and substantial proportions of children were designated at risk on the factors of parent education, family composition, housing stability, and minority status. Fewer children were at risk in terms of health status, special needs, and English profi ciency, although children typically had multiple risk factors.

n Programs were also serving the intended population based on service priority status. Three-quarters of the children had not been previously served, which was the primary targeted group. In addition, another 12% were eligible for fi nancial assistance but not receiving it, and another 5% were being served in below-standard settings.

What were the characteristics of the children served in the More at Four Program?n The More at Four Program served a diverse group of children based on characteristics such as gender, ethnicity, types of risk factors, and family composition. Of all children participating in the program during the fi rst year, about half were boys and half girls; 40% were African-American, 35% White, 15% Latino, and 10% from other ethnic/racial groups or combinations of groups. There was a great deal of variety in the types and combinations of risk factors children exhibited, with 10% to 90% of the children designated at risk on the individual risk factors, and an average total risk factor score of 5.6 (with a range from 0-15). Children lived in households with an average of 1.8 adults, suggesting than many children were not living in 2-parent families, although the number of adults ranged from 1-6.

4 | More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program 5

n The More at Four Program served a signifi cant proportion of children with disabilities, 13%, which is higher than the estimated US population average of 6% (US Census Bureau, 1995). Five percent of all children attending More at Fourwere referred for a disability evaluation during their tenure in More at Four, and almost 80% More at Four, and almost 80% More at Fourof the children with identifi ed disabilities had an active IEP and were receiving special services.

Were the individual sites meeting the program guidelines for operation?n For the most part, the various sites were meeting program guidelines for operation. The average number of hours of operation was 6.8, or about the length of a school day, and the average class size was 14.4 (well below the maximum of 18). They were also meeting the guidelines in terms of staff qualifi cations: 81% of the lead teachers had bachelor’s degrees or above, although only 29% had a B-K or preschool add-on licensure; 43% of assistant teachers had an associate’s degree or above and 43% held a CDA credential or above; and 89% of the principals/site directors had bachelor’s degrees or above and 77% had a Child Care Level III certifi cation or a Principal’s Certifi cation.

n Because of the timing of the availability of funds for the More at Four Program, there was a short program year for the fi rst year, with a start-up in the middle of the school year. Individual grantees started serving children between January and April, 2002. Children attended the program for an average of 48 days (about 2 full months of services).

What were the characteristics of the programs that served More at Four children?

n The settings for service delivery varied on a number of characteristics. Children were served in a variety of setting types, including public schools, for-profi t and nonprofi t private child care, Head Start, and various other combinations, with about two-thirds (65%) in public school sites. More at Four children tended to be served in blended Four children tended to be served in blended Fourclassrooms, including children funded through other programs. The average number of More at Four children per classroom was 10, representing 62% of the class.

n There was a great deal of variation among grantees on a number of program characteristics, including program size, length of operation, children’s risk factor status, and types of settings. The More at Four programs conducted by individual grantees ranged in size from 7 to 118 children and ranged in length of operation from 26 to 90 days, with start-up dates from January to April. The average child risk factor score ranged from 3.8 to 6.8 across grantees, and there may have been variations in the modifi cations, if any, that grantees made to the specifi c defi nitions of risk. Individual grantees also varied in the types of sites in which they served children; for example, the percentage of children served in public school sites and private child care sites varied from 0-100%, while the percentage served in Head Start sites varied from 0-52%.

4 More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program | 5

Results

I. Slots Allocated and Filled

Total Number of Slots

Allocated by Month

Total Number of Slots Filled

(Children Served)

by Month

Percent of Allocated Slots that were Filled

by Month

January 803 318 39.6%February 857 568 66.3%March 1312 923 70.4%April 1479 1176 79.5%May 1351 1181 87.4%June 1146Total 1234

II. Service Priority Status

Total Number of Children Served Who Have Not Been Previously

Served Based on Service Priority Status by Month

Total Number of Children Served Who Have Not Been Previously

Served in a Licensed or Regulated Child Care Setting by Month

January 235 242February 449 460March 718 726April 877 892May 882 897June 853 868Total 919 935

6 | More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program 7

III. Child Attendance, Enrollment, and WithdrawalTotal Child Attendance by Month*

Number of Children

Number of Days

Attended

Mean Days per

Child

SD Days per

Child

January 294 1925 6.5 6.1February 542 7754 14.3 6.0March 908 12,041 13.3 6.1April 1157 17,976 15.5 4.0May 1167 19,501 16.7 4.4Total 1233 59,197 48.0 21.9

*Note: Attendance data were not reported for 11 children.

Frequency of Child Enrollments* and Withdrawals by Month

Enrollments Withdrawals

Percent Number Percent Number

January 24.8 305 --- ---

February 20.3 250 9.4 10

March 29.7 365 17.8 19

April 22.1 272 31.8 34

May 3.2 39 32.7 35

June --- --- 8.4 9*Note: Enrollment data were not reported for 13 children.

6 More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program | 7

IV. Operation Days and Hours

Average Operation Days by Month (for sites in operation that month)

Service Days for Children Teacher Workdays

Number of Sites Mean SD Range Mean SD Range

January 51 13.6 7.4 2-22 0.8 2.2 0-15February 62 18.1 3.4 3-25 0.5 0.7 0-2March 85 16.1 5.2 2-21 1.3 2.5 0-19April 100 17.6 2.9 7-22 0.8 1.9 0-10May 100 19.9 2.9 10-24 1.5 2.3 0-9June 38 11.5 7.2 2-20 1.3 1.7 0-7Total (Jan-June)

101 73.0 28.2 23-127 5.2 5.6 0-28

Note: The start date for More at Four services ranged from 1/7/03 to 4/22/03, and the end date ranged from 5/14/03 to 8/8/03.More at Four services ranged from 1/7/03 to 4/22/03, and the end date ranged from 5/14/03 to 8/8/03.More at Four

Average Hours per Day of Operation for More at Four ServicesMore at Four ServicesMore at Four

Mean SD Range

6.8 1.2 5-11

V. Class Size CharacteristicsAverage Class Size

Mean SD Range

14.0 3.7 2-20

Average Number of More at Four Children per Class

Mean SD Range

8.7 6.7 1-18

Average Proportion of More at Four Children per Class

Mean SD Range

0.62 0.40 0.06-1.00

8 | More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program 9

VI. Staff CharacteristicsTotal Number of Teachers by Month

Lead Teachers

Assistant Teachers

Long-term Substitutes

January 67 68 7February 85 96 8March 122 133 7April 134 151 9May 136 151 7June 53 61 1Total 140 155 13

*Note: Data were included for 4 teachers with no category indicated.

Distribution of Highest Teacher Education Level*

Lead Teachersn=133

Assistant Teachersn=148

Highest Education Level Percent Number Percent Number

High School Diploma 0.8 1 28.4 42Working toward AA/AAS 6.8 9 28.4 42AA/AAS Degree 6.0 8 16.9 25Working toward BA/BS 5.3 7 8.8 13BA/BS Degree 63.2 84 15.5 23Working toward MA/MS 3.8 5 1.4 2MA/MS Degree or higher 14.3 19 0.7 1

*Note: Data were not reported for 7 lead teachers and 7 assistant teachers. In addition, data are not included for 4 teachers with no category indicated and for 13 teachers categorized as substitutes.

Distribution of Highest Teacher Credential/Certifi cation Levels*

Lead Teachersn=112

Assistant Teachersn=89

Highest Certifi cation Level Percent Number Percent Number

B-K or Preschool Add-on License 28.6 32 2.3 2NC Teacher’s License 38.4 43 2.3 2Other State Teacher’s License 2.7 3 0 0Working toward B-K or Preschool Add-on 19.6 22 9.0 8Working toward Teacher’s License 0.9 1 6.7 6CDA (Child Development Associate) Credential 0.9 1 22.5 20Working toward CDA Credential 1.8 2 10.1 9NC Early Childhood Credential 2.7 3 29.2 26Working toward NC Early Childhood Credential 1.8 2 11.2 10Other 2.7 3 6.7 6

*Note: No data were reported for 28 lead teachers and 66 assistant teachers. Data are not included for 4 teachers with no category indicated and for 13 teachers categorized as substitutes.

8 More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program | 9

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10 | More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program 11

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10 More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program | 11

Total Number of Directors/Principals by Month*

January 40February 54March 83April 100May 100June 40Total 101

*Note: This information was not reported for one site.

Distribution of Director/Principal Education* (n=100)

Highest Education Level Percent Number

High School Diploma 1.0 1Working toward AA/AAS 2.0 2AA/AAS Degree 3.0 3Working toward BA/BS 5.0 5BA/BS Degree 16.0 16Working toward MA/MS 3.0 3MA/MS Degree 57.0 57Working toward Ph.D./Ed.D. 4.0 4Ph.D./Ed.D. 9.0 9

*Note: This information was not reported for two sites.

Distribution of Director/Principal Credentials* (n=97)

Certifi cation Percent Number

Principal’s Certifi cation 50.5 49Working toward Principal’s Certifi cation 0 0Child Care Administrator Level III 16.5 16Working toward Child Care Administrator Level III 10.3 10Child Care Administrator Level II 7.2 7Working toward Child Care Administrator Level II 1.0 1Child Care Administrator Level I 5.2 5Working toward Child Care Administrator Level I 1.0 1Other 8.3 8

*Note: This information was not reported for fi ve sites.

12 | More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program 13

VII. Setting CharacteristicsDistribution of Types of More at Four Sites (n=102)More at Four Sites (n=102)More at Four

Site Type Percent Number

Public School District 55.9 57Private Nonprofi t Child Care Center 17.6 18Private For-profi t Child Care Center 7.8 8Public School, Head Start, and Private Nonprofi t 6.9 7Head Start 4.9 5Public School and Head Start 2.0 2Public Charter School 1.0 1Other 1.0 1Private For-profi t and Nonprofi t 1.0 1Public School and Private Nonprofi t 1.0 1Private Nonprofi t and Other 1.0 1

Distribution of Children by Type of More at Four Site (n=1244)More at Four Site (n=1244)More at Four

Site Type Percent Number

Public School District 65.0 808Private For-profi t Child Care Center 10.1 126Private Nonprofi t Child Care Center 8.8 110Head Start 7.0 87Public School and Head Start 2.3 29Public School and Private Nonprofi t 1.7 21Public School, Head Start, and Private Nonprofi t 1.6 20Private For-profi t and Nonprofi t 1.4 18Public Charter School 0.9 11Private Nonprofi t and Other 0.8 10Other 0.3 4

12 More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program | 13

Distribution of Types of More at Four Classrooms (n=139)More at Four Classrooms (n=139)More at Four

Classroom Type Percent Number

Public Preschool 54.0 75Private Child Care Center 21.6 30Head Start 11.5 16Head Start, Public Preschool, and Private 7.2 10Public Preschool and Other 2.9 4Other 2.2 3Private Center and Other 0.7 1

Distribution of Children by Type of More at Four Classroom* (n=1243)More at Four Classroom* (n=1243)More at Four

Classroom TypePercent of Children

Number of Children

Public Preschool 62.0 771Private Child Care Center 20.7 257Head Start 11.5 143Other 2.0 25Private Center and Other 1.7 21Head Start, Public Preschool, and Private 1.6 20Public Preschool and Other 0.5 6

*Note: This information was not reported for one child.

VIII. Child CharacteristicsChild Age (at end of school year in June)

Mean SD Range N

5.0 0.40 3.2 - 6.3 1234

Child Gender

Female Male N

49.0%(610)

51.0%(634) 1244

14 | More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program 15

Child Ethnicity/Race (n=1239)

Ethnicity/Race Percent Frequency

Black/African American 40.1 499

White/European American 34.5 429

Hispanic/Latino 15.0 186

Native American/Alaskan Native 4.8 60

Asian 2.6 32

White/European American and Black/African American 1.1 14

White/European American and Hispanic/Latino 0.6 8

Native Hawaiian/Pacifi c Islander 0.2 2

Black/African American and Hispanic/Latino 0.2 2

White/European American and Asian 0.2 2

White/European American and Native American/Alaskan Native 0.2 3

Native Hawaiian/Pacifi c Islander and Hispanic/Latino 0.1 1

White/European American and Black/African American and Native Hawaiian/Pacifi c Islander and Hispanic/Latino 0.1 1

Note: These data were not reported for 5 children.

Overall Level of Child Risk Factors (n=1224-1242)

Level 0 Level 1 Level 2

Risk Factor Percent Number Percent Number Percent Number

Family Income 9.5 118 12.2 151 78.3 973Health Status 85.4 1060 10.5 130 4.1 51Special Needs 91.1 1128 1.3 16 7.6 94Parent Education 62.5 775 10.5 130 27.0 335Parent Employment 39.1 483 17.3 214 43.5 537Family Composition 53.7 667 39.1 485 7.3 90Housing Stability 69.1 855 29.2 361 1.8 22English Profi ciency 82.3 1018 8.7 108 9.0 111Minority Status 51.2 625* 25.8 315 23.0 280

*Note: This number includes 389 children scored n/a and 236 children scored level 0.

14 More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program | 15

Average Total Risk Factor Score

Mean SD RangePossible Range N

5.6 3.0 0-15 0-18 1242

Overall Distribution of Children’s Service Priority Status at Enrollment* (n=1240)

Status Percent Number

Never been served 74.7 926Eligible for fi nancial assistance, but not receiving 11.9 147Currently served in setting below MAF standards 4.7 58Other 8.8 109

Note: These data were not reported for 4 children.

Has child ever been served in a licensed or regulated child care setting?

Status Percent Number

Never been served 76.1 943Have been served 23.9 296

Note: These data were not reported for 5 children.

Family Composition of More at FourFamily Composition of More at FourFamily Composition of Children More at Four Children More at Four

Household Composition Mean SD Range N

Number of adults 1.8 0.7 1-6 1238Number of children 2.4 1.2 1-10 1226Total number of people 4.3 1.5 2-14 1225

16 | More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program 17

IX. Information on Children’s Disability StatusFrequency of Children Receiving Referrals for Disability Evaluation*

Referrals for Disability Evaluation Percent Number

Never referred 87.0% 1080Referred prior to MAF 8.2% 102Referred during MAF 4.8% 59

*Note: These data were not reported for 3 children.

Frequency of Types of Disability Evaluation Decisions (for children who are referred)

Evaluation Decision Percent Number

No disability identifi ed 7.1% 11Decision in progress 21.8% 34One or more disabilities identifi ed 71.2% 111

*Note: These data were not reported for 8 children.

Frequency of Categories of Identifi ed Disabilities* (n=113)

Disability Percent Number

Autistic 8.0 9Deaf-Blind 0 0Behaviorally/Emotionally Disabled 9.7 11Educable Mentally Disabled 0 0Hearing Impaired 0.9 1Specifi c Learning Disabled 0.9 1Multi-handicapped 0 0Other Health Impaired 5.3 6Orthopedically Impaired 2.7 3Speech/Language Impaired 78.8 89Severe/Profound Mentally Disabled 0 0Trainable Mentally Disabled 0 0Visually Impaired 4.4 5Traumatic Brain Injured 0.9 1Preschool Developmentally Delayed 23.9 27

*Note: More than one category was indicated for 27 children.

Of the children with identifi ed disabilities, how many:

Percent Number

Have an active IEP1 7.1% 11Have been referred for services2 21.8% 34One or more disabilities identifi ed3 71.2% 111

1 Note: This information was not reported for 1 child.2 Note: This information was not reported for 15 children.3 Note: This information was not reported for 13 children.

16 More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program | 17

X. G

rant

ee-L

evel

Info

rmat

ion

Gra

ntee

*

Number of Sites

Number of Classrooms

Slots Allocated

Number of Children

Average Risk Total

Number of Children Never Served based on Service Priority Status

Number of Children Not Previously Served in Licensed/ Regulated Care

Average Days of Operation per siteJan-June

Average Days of Attendance per ChildJan-May

Month Began Serving Children

Alam

ance

34

2418

8.4

1717

---12

.9Ap

rAs

he1

115

156.

215

1578

.047

.5Ja

nBe

aufo

rt3

472

775.

645

4679

.760

.0Ja

nBu

ncom

be3

1024

205.

913

1290

.056

.6Ja

nC

arte

ret

45

6151

4.5

3737

45.3

39.8

Mar

Cat

awba

33

5456

6.0

4949

74.3

58.9

Jan

Cra

ven

22

2824

5.5

2220

31.5

25.5

Mar

Cum

berla

nd7

711

298

6.8

9090

68.4

47.4

Feb

Dav

idso

n5

696

895.

151

5146

.236

.1M

arFo

rsyt

h6

691

666.

141

3937

.231

.6Ap

rG

asto

n2

236

234.

313

1437

.032

.0M

arG

ranv

ille1

116

176.

215

1541

.038

.6M

arG

uilfo

rd6

711

811

83.

873

7288

.875

.2Ja

nH

ertfo

rd2

215

216.

817

2143

.535

.4Ap

rH

oke

67

9093

5.2

8087

73.0

59.1

Jan

Mec

klen

burg

23

5454

6.3

5151

78.5

59.3

Jan

New

Han

over

210

3637

6.8

2729

---33

.1M

arN

orth

ampt

on3

254

74.

34

530

.530

.3Ap

rO

rang

e11

1475

736.

925

2775

.744

.6Ja

nPa

mlic

o1

115

155.

713

1441

.029

.9M

arR

egio

n A

1823

106

644.

264

6411

2.2

56.0

Jan

Rob

eson

39

5863

6.6

4753

68.3

42.5

Feb

Scot

land

12

3624

5.5

2122

48.0

37.7

Mar

Vanc

e1

118

143.

814

1426

.025

.1Ap

rW

ake

34

9056

5.9

3333

55.0

33.0

Mar

Way

ne3

354

514.

249

4667

.050

.8Fe

b*N

ote:

Tw

o ad

ditio

nal g

rant

ees,

Ans

on a

nd B

runs

wic

k co

untie

s, w

ere

appr

oved

but

did

not

ser

ve c

hild

ren.

18 | More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program 19

Num

ber o

f Chi

ldre

n by

Typ

e of

Site

Gra

ntee

Public School

Private For-profi t Center

Private Nonprofi t Center

Head Start

Public School/ Head Start

Public School/ Private Nonprofi t

Public School/ Head Start/ Private Nonprofi t

Private For-Profi t and Nonprofi t

Public Charter School

Private Nonprofi t and Other

Other

Alam

ance

18

(100

%)

00

00

00

00

00

Ashe

15 (1

00%

)0

00

00

00

00

0

Beau

fort

56

(72.

7%)

00

00

21

(27.

2%)

00

00

0

Bunc

ombe

6 (3

0.0%

)0

00

10

(50.

0%)

00

00

04

(20.

0%)

Car

tere

t38

(7

4.5%

)13

(2

5.5%

)0

00

00

00

00

Cat

awba

56

(100

%)

00

00

00

00

00

Cra

ven

24

(100

%)

00

00

00

00

00

Cum

berla

nd63

(6

4.3%

)13

(1

3.3%

)12

(1

2.2%

)0

00

00

010

(1

0.2%

)0

Dav

idso

n74

(8

3.1%

)0

15

(16.

9%)

00

00

00

00

Fors

yth

34

(51.

5%)

21

(31.

8%)

00

00

00

11

(16.

7%)

00

Gas

ton

9 (3

9.1%

)14

(6

0.9%

)0

00

00

00

00

Gra

nville

17

(100

%)

00

00

00

00

00

Gui

lford

54

(45.

8%)

027

(2

2.9%

)37

(3

1.4%

)0

00

00

00

18 More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program | 19

Num

ber o

f Chi

ldre

n by

Typ

e of

Site

, con

tinue

d

Gra

ntee

Public School

Private For-profi t Center

Private Nonprofi t Center

Head Start

Public School/ Head Start

Public School/ Private Nonprofi t

Public School/ Head Start/ Private Nonprofi t

Private For-Profi t and Nonprofi t

Public Charter School

Private Nonprofi t and Other

Other

Her

tford

10

(47.

6%)

00

11

(52.

4%)

00

00

00

0

Hok

e74

(7

9.6%

)0

00

19

(20.

4%)

00

00

00

Mec

klen

burg

36

(66.

7%)

18

(33.

3%)

00

00

00

00

0

New

Han

over

18

(48.

6%)

00

19

(51.

4%)

00

00

00

0

Nor

tham

pton

7 (1

00%

)0

00

00

00

00

0

Ora

nge

46

(63.

0%)

07

(9.6

%)

00

020

(2

7.4%

)0

00

0

Pam

lico

15

(100

%)

00

00

00

00

00

Reg

ion

A41

(6

4.1%

)0

20

(31.

3%)

3 (4

.7%

)0

00

00

00

Rob

eson

43

(68.

3%)

20

(31.

7%)

00

00

00

00

0

Scot

land

24

(100

%)

00

00

00

00

00

Vanc

e14

(1

00%

)0

00

00

00

00

0

Wak

e0

27

(48.

2%)

29

(51.

8%)

00

00

00

00

Way

ne16

(3

1.4%

)0

017

(3

3.3%

)0

00

18

(35.

3%)

00

0

*Not

e: T

wo

addi

tiona

l gra

ntee

s, A

nson

and

Bru

nsw

ick

coun

ties,

wer

e ap

prov

ed b

ut d

id n

ot s

erve

chi

ldre

n.

20 More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program | 21

Appendix AChild- and Program-Specifi c Reporting Forms for Spring 2002

22 | More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program 23

(For

offi

ce u

se o

nly)

_ _

/20

01-2

002

Cnty

Yea

r

Con

trac

t Adm

inis

trat

or F

orm

• Pa

ge 1

Mor

e at

Fou

r Rep

ort

Con

tract

Adm

inis

trato

r For

m6

item

s

Ref

er to

Con

tract

Adm

inis

trato

r For

m In

stru

ctio

ns

1.R

epor

ting

date

(m

m-d

d-yy

yy)

2.M

ore

at F

our c

ount

y or

regi

on

3.Ad

min

istra

tive

agen

cy fo

r Mor

e at

Fou

r con

tract

4.M

ore

at F

our p

rogr

am c

onta

ct n

ame

(per

son

com

plet

ing

this

form

)

5.M

ore

at F

our p

rogr

am c

onta

ct p

hone

num

ber

(Incl

ude

area

cod

e)

6.N

umbe

r of M

ore

at F

our s

lots

allo

cate

d fo

r thi

s gr

ant b

y m

onth

(E

nter

a n

umbe

r for

eac

h m

onth

)

Janu

ary

Febr

uary

Mar

chAp

rilM

ay

End

of C

ontra

ct A

dmin

istra

tor F

orm

Che

cklis

t:ü

Mak

e su

re th

at e

very

thin

g is

spe

lled

corre

ctly

ü

Mak

e su

re th

at a

ll fie

lds

are

fille

d ou

t

ü

Prin

t out

the

form

for s

endi

ng to

FPG

ü

Prin

t (or

pho

toco

py) a

cop

y fo

r you

r rec

ords

ü

Bund

le fo

rms

toge

ther

as

expl

aine

d in

Inst

ruct

ions

22 More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program | 23

(For

offi

ce u

se o

nly)

_ _

/_

_ _

_ /2

001-

2002

Cnty

Site

Yea

r

Site

For

m •

Page

1 o

f 2

M

ore

at F

our R

epor

t

Site

For

m11

item

sC

ompl

ete

one

for

each

Site

Ref

er to

Site

For

m In

stru

ctio

ns1.

Rep

ortin

g da

te

(mm

-dd-

yyyy

)

2.C

ount

y w

here

Mor

e at

Fou

r Site

is lo

cate

d

3.M

ore

at F

our S

ite n

ame

4.Ty

pe o

f age

ncy

this

Site

is p

art o

f:

(che

ck a

ll th

at a

pply

and

indi

cate

nam

e of

age

ncy)

Publ

ic s

choo

l dis

trict

: ...

......

......

......

......

..Pu

blic

cha

rter s

choo

l: ...

......

......

......

......

.H

ead

Star

t: ...

......

......

......

......

......

......

......

.Pr

ivat

e fo

r-pro

fit c

hild

car

e ce

nter

: ....

...Pr

ivat

e no

n-pr

ofit

child

car

e ce

nter

: ...

.O

ther

:.....

......

......

......

......

......

......

......

......

....

5.M

ore

at F

our S

ite D

irect

or/P

rinci

pal n

ame

6.D

irect

or/P

rinci

pal p

hone

num

ber

(incl

ude

area

cod

e)

7.D

irect

or/P

rinci

pal i

nfor

mat

ion

(Che

ck a

ll th

at a

pply

)

Educ

atio

nPh

.D. o

r Ed.

D.,

spec

ify m

ajor

Wor

king

tow

ard

Ph.D

. or E

d.D

.M

A/M

S or

hig

her d

egre

e, s

peci

fy m

ajor

Wor

king

tow

ard

MA/

MS

or h

ighe

r deg

ree

BA/B

S de

gree

, spe

cify

maj

or

Wor

king

tow

ard

BA/B

S de

gree

AA o

r AAS

deg

ree,

spe

cify

maj

or

Wor

king

tow

ard

AA o

r AAS

deg

ree

Hig

h S

choo

l dip

lom

a or

GE

DLe

ss th

an o

r wor

king

tow

ard

Hig

h S

choo

l or G

ED

Cer

tific

atio

ns/C

rede

ntia

lsP

rinci

pal’s

Cer

tific

atio

nW

orki

ng to

war

d P

rinci

pal’s

Cer

tific

atio

nC

hild

Car

e Ad

min

istra

tor C

ertif

icat

ion

(CC

AC) L

evel

III

Wor

king

tow

ard

CC

AC L

evel

III

Chi

ld C

are

Adm

inis

trato

r Cer

tific

atio

n Le

vel I

IW

orki

ng to

war

d C

CAC

Lev

el II

Chi

ld C

are

Adm

inis

trato

r Cer

tific

atio

n Le

vel I

Wor

king

tow

ard

CC

AC L

evel

IO

ther

(spe

cify

bel

ow)

8.N

umbe

r of o

pera

tion

days

for t

his

site

eac

h m

onth

(Che

ck th

e bo

x ne

xt to

eac

h da

y th

at th

e si

te w

as in

ope

ratio

n an

d se

rvin

g ch

ildre

n. D

o no

t che

ck a

box

fo

r a te

ache

r wor

kday

)

Janu

ary

2002

Sun

Mon

Tue

Wed

Thur

Fri

Sat

12

34

56

78

910

1112

1314

1516

1718

1920

2122

2324

2526

2728

2930

31

Febr

uary

200

2Su

nM

onTu

eW

edTh

urFr

iSa

t1

23

45

67

89

1011

1213

1415

1617

1819

2021

2223

2425

2627

28 cont

inue

d on

nex

t pag

e

(For

offi

ce u

se o

nly)

_ _

/_

_ _

_ /

2001

-200

2Cn

tySi

teY

ear

Site

For

m •

Page

2 o

f 2

M

ore

at F

our R

epor

t

Mar

ch 2

002

Sun

Mon

Tue

Wed

Thur

Fri

Sat

12

34

56

78

910

1112

1314

1516

1718

1920

2122

2324

2526

2728

2930

31

May

200

2Su

nM

onTu

eW

edTh

urFr

iSa

t1

23

45

67

89

1011

1213

1415

1617

1819

2021

2223

2425

2627

2829

3031

Apr

il 20

02Su

nM

onTu

eW

edTh

urFr

iSa

t1

23

45

67

89

1011

1213

1415

1617

1819

2021

2223

2425

2627

2829

30

June

200

2Su

nM

onTu

eW

edTh

urFr

iSa

t1

23

45

67

89

1011

1213

1415

1617

1819

2021

2223

2425

2627

2829

30

9.D

ates

of t

each

er w

orkd

ays

at th

is s

ite b

y m

onth

(Ent

er d

ate

or d

ates

of t

each

er w

orkd

ays

for e

ach

mon

th, f

orm

atte

d as

mm

/dd/

yyyy

)

Janu

ary

Febr

uary

Mar

chAp

rilM

ayJu

ne

10.

End

date

of M

ore

at F

our s

ervi

ces

(Ent

er d

ate

as m

m/d

d/yy

yy o

r che

ck N

A)11

.N

umbe

r of M

ore

at F

our

slot

s al

loca

ted

for t

his

site

eac

h m

onth

Janu

ary

Febr

uary

Mar

chAp

rilM

ay

End

of S

ite F

orm

Che

cklis

t:ü

Mak

e su

re th

at e

very

thin

g is

spe

lled

corre

ctly

ü

Mak

e su

re th

at a

ll fie

lds

are

fille

d ou

t

ü

Prin

t out

the

form

for s

endi

ng to

FPG

ü

Prin

t (or

pho

toco

py) a

cop

y fo

r you

r rec

ords

ü

Bund

le fo

rms

toge

ther

as

expl

aine

d in

Inst

ruct

ions

Site

Nam

e:

24 | More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program 25

(For

offi

ce u

se o

nly)

_ _

/_

_ _

_ /

_ _

_ _

/20

01-2

002

Cnty

Site

Cla

ssro

om

Yea

r

Cla

ssro

om F

orm

• Pa

ge 1

of 3

Mor

e at

Fou

r Rep

ort

Cla

ssro

om F

orm

11 it

ems

Com

plet

e on

e fo

r ea

chcl

assr

oom

Ref

er to

Cla

ssro

om F

orm

Inst

ruct

ions

1.R

epor

ting

date

(m

m-d

d-yy

yy)

2.C

ount

y w

here

Cla

ssro

om is

loca

ted

(as

on S

ite F

orm

)

3.Si

tew

here

Cla

ssro

om is

loca

ted

(as

on S

ite F

orm

)

4.Ty

pe o

f cla

ssro

om s

ervi

ng M

ore

at F

our c

hild

ren:

(Che

ck a

ll th

at a

pply

. Spe

cify

if O

ther

)

Hea

d St

art c

lass

room

Publ

ic p

re-K

cla

ssro

omPr

ivat

e ch

ild c

are

cent

er c

lass

room

Oth

er ty

pe o

f cla

ssro

om, s

peci

fy b

elow

5.C

lass

room

cod

e(s

ee C

lass

room

For

m In

stru

ctio

ns)

6.D

ate

that

firs

t Mor

e at

Fou

r Chi

ld e

nrol

led

7.M

ore

at F

our c

lass

room

sta

rt tim

e (h

h:m

m, a

m/p

m)

8.M

ore

at F

our c

lass

room

end

tim

e (h

h:m

m, a

m/p

m)

9.C

lass

siz

e (s

lots

fille

d) b

y m

onth

, inc

ludi

ng M

ore

at F

our

and

non-

Mor

e at

Fou

r chi

ldre

n

Janu

ary

Febr

uary

Mar

chAp

rilM

ay

10.

Num

ber o

f Mor

e at

Fou

r slo

ts a

lloca

ted

for t

his

clas

sroo

m e

ach

mon

th

Janu

ary

Febr

uary

Mar

chAp

rilM

ay

cont

inue

d on

nex

t pag

e

Lead

Tea

cher

Firs

t an

d La

st N

ame:

(For

offi

ce u

se o

nly)

_ _

/_

_ _

_ /

_ _

_ _

/20

01-2

002

Cnty

Site

Cla

ssro

omYe

ar

Cla

ssro

om F

orm

• Pa

ge 2

of 3

Mor

e at

Fou

r Rep

ort

11.

Mor

e at

Fou

r Tea

cher

s(P

rovi

de in

form

atio

n on

any

Lea

d, A

ssis

tant

, or L

ong-

Term

Sub

stitu

te T

each

er th

at w

as

in th

e M

ore

at F

our c

lass

room

. Ent

er in

form

atio

n ab

out t

he c

urre

nt L

ead

Teac

her f

irst.)

11a.

Lead

Firs

t nam

eLa

st n

ame

Entry

dat

e

NA

Exit

date

NA

Educ

atio

n(C

heck

all

that

app

ly)

MA/

MS

or h

ighe

r deg

ree,

spe

cify

maj

or

Wor

king

tow

ard

MA/

MS

or h

ighe

r deg

ree

BA/B

S de

gree

, spe

cify

maj

or

Wor

king

tow

ard

BA/B

S de

gree

AA/A

AS d

egre

e, s

peci

fy m

ajor

Wor

king

tow

ard

AA/A

AS d

egre

eH

igh

Scho

ol d

iplo

ma/

GED

Less

than

or w

orki

ng to

war

d H

igh

Scho

ol/G

ED

Cer

tific

atio

ns/C

rede

ntia

ls(C

heck

all

that

app

ly)

NC

teac

her's

lice

nse,

spe

cify

are

a

Anot

her s

tate

’s te

ache

r's lic

ense

,spe

cify

are

a

Wor

king

tow

ard

teac

her's

lice

nse

B-K

or p

resc

hool

add

-on

licen

sure

Wor

king

tow

ard

B-K

or p

resc

hool

add

-on

licen

sure

CD

A (C

hild

Dev

elop

men

t Ass

ocia

te) c

rede

ntia

lW

orki

ng to

war

d C

DA

cred

entia

lN

C e

arly

chi

ldho

od c

rede

ntia

lW

orki

ng to

war

d N

C e

arly

chi

ldho

od c

rede

ntia

lO

ther

,spe

cify

11b.

Lead

Ass

ista

ntLo

ng-T

erm

Subs

titut

e

Firs

t nam

eLa

st n

ame

Entry

dat

e

NA

Exit

date

NA

Educ

atio

n(C

heck

all

that

app

ly)

MA/

MS

or h

ighe

r deg

ree,

spe

cify

maj

or

Wor

king

tow

ard

MA/

MS

or h

ighe

r deg

ree

BA/B

S de

gree

, spe

cify

maj

or

Wor

king

tow

ard

BA/B

S de

gree

AA/A

AS d

egre

e, s

peci

fy m

ajor

Wor

king

tow

ard

AA/A

AS d

egre

eH

igh

Scho

ol d

iplo

ma/

GED

Less

than

or w

orki

ng to

war

d H

igh

Scho

ol/G

ED

Cer

tific

atio

ns/C

rede

ntia

ls(C

heck

all

that

app

ly)

NC

teac

her's

lice

nse,

spec

ify a

rea

Anot

her s

tate

’s te

ache

r's li

cens

e, s

peci

fy a

rea

Wor

king

tow

ard

teac

her's

lice

nse

B-K

or p

resc

hool

add

-on

licen

sure

Wor

king

tow

ard

B-K

or p

resc

hool

add

-on

licen

sure

CD

A (C

hild

Dev

elop

men

t Ass

ocia

te) c

rede

ntia

lW

orki

ng to

war

d C

DA

cred

entia

lN

C e

arly

chi

ldho

od c

rede

ntia

lW

orki

ng to

war

d N

C e

arly

chi

ldho

od c

rede

ntia

lO

ther

,spe

cify

11c.

Lead

Ass

ista

ntLo

ng-T

erm

Subs

titut

e

Firs

t nam

eLa

st n

ame

Entry

dat

e

NA

Exit

date

NA

Educ

atio

n(C

heck

all

that

app

ly)

MA/

MS

or h

ighe

r deg

ree,

spe

cify

maj

or

Wor

king

tow

ard

MA/

MS

or h

ighe

r deg

ree

BA/B

S de

gree

, spe

cify

maj

or

Wor

king

tow

ard

BA/B

S de

gree

AA/A

AS d

egre

e, s

peci

fy m

ajor

Wor

king

tow

ard

AA/A

AS d

egre

eH

igh

Scho

ol d

iplo

ma/

GED

Less

than

or w

orki

ng to

war

d H

igh

Scho

ol/G

ED

Cer

tific

atio

ns/C

rede

ntia

ls(C

heck

all

that

app

ly)

NC

teac

her's

lice

nse,

spe

cify

are

a

Anot

her s

tate

’s te

ache

r's li

cens

e, s

peci

fy a

rea

Wor

king

tow

ard

teac

her's

lice

nse

B-K

or p

resc

hool

add

-on

licen

sure

Wor

king

tow

ard

B-K

or p

resc

hool

add

-on

licen

sure

CD

A (C

hild

Dev

elop

men

t Ass

ocia

te) c

rede

ntia

lW

orki

ng to

war

d C

DA

cred

entia

lN

C e

arly

chi

ldho

od c

rede

ntia

lW

orki

ng to

war

d N

C e

arly

chi

ldho

od c

rede

ntia

lO

ther

,spe

cify

cont

inue

d on

nex

t pag

e

•

Lead

Tea

cher

Firs

tan

d La

st N

ame:

and

Last

Nam

e:

24 More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program | 25

(For

offi

ce u

se o

nly)

_ _

/_

_ _

_ /

_ _

_ _

/200

1-20

02Cn

tySi

teC

lass

room

Year

Cla

ssro

om F

orm

• Pa

ge 3

of 3

Mor

e at

Fou

r Rep

ort

11d.

Lead

Ass

ista

ntLo

ng-T

erm

Subs

titut

e

Firs

t nam

eLa

st n

ame

Entry

dat

e

NA

Exit

date

NA

Educ

atio

n(C

heck

all

that

app

ly)

MA/

MS

or h

ighe

r deg

ree,

spe

cify

maj

or

Wor

king

tow

ard

MA/

MS

or h

ighe

r deg

ree

BA/B

S de

gree

, spe

cify

maj

or

Wor

king

tow

ard

BA/B

S de

gree

AA/A

AS d

egre

e, s

peci

fy m

ajor

Wor

king

tow

ard

AA/A

AS d

egre

eH

igh

Scho

ol d

iplo

ma/

GED

Less

than

or w

orki

ng to

war

d H

igh

Scho

ol/G

ED

Cer

tific

atio

ns/C

rede

ntia

ls(C

heck

all

that

app

ly)

NC

teac

her's

lice

nse,

spe

cify

are

a

Anot

her s

tate

’s te

ache

r's li

cens

e, s

peci

fy a

rea

Wor

king

tow

ard

teac

her's

lice

nse

B-K

or p

resc

hool

add

-on

licen

sure

Wor

king

tow

ard

B-K

or p

resc

hool

add

-on

licen

sure

CD

A (C

hild

Dev

elop

men

t Ass

ocia

te) c

rede

ntia

lW

orki

ng to

war

d C

DA

cred

entia

lN

C e

arly

chi

ldho

od c

rede

ntia

lW

orki

ng to

war

d N

C e

arly

chi

ldho

od c

rede

ntia

lO

ther

,spe

cify

11e.

Lead

Ass

ista

ntLo

ng-T

erm

Subs

titut

e

Firs

t nam

eLa

st n

ame

Entry

dat

e

NA

Exit

date

NA

Educ

atio

n(C

heck

all

that

app

ly)

MA/

MS

or h

ighe

r deg

ree,

spe

cify

maj

or

Wor

king

tow

ard

MA/

MS

or h

ighe

r deg

ree

BA/B

S de

gree

, spe

cify

maj

or

Wor

king

tow

ard

BA/B

S de

gree

AA/A

AS d

egre

e, s

peci

fy m

ajor

Wor

king

tow

ard

AA/A

AS d

egre

eH

igh

Scho

ol d

iplo

ma/

GED

Less

than

or w

orki

ng to

war

d H

igh

Scho

ol/G

ED

Cer

tific

atio

ns/C

rede

ntia

ls(C

heck

all

that

app

ly)

NC

teac

her's

lice

nse,

spe

cify

are

a

Anot

her s

tate

’s te

ache

r's li

cens

e, s

peci

fy a

rea

Wor

king

tow

ard

teac

her's

lice

nse

B-K

or p

resc

hool

add

-on

licen

sure

Wor

king

tow

ard

B-K

or p

resc

hool

add

-on

licen

sure

CD

A (C

hild

Dev

elop

men

t Ass

ocia

te) c

rede

ntia

lW

orki

ng to

war

d C

DA

cred

entia

lN

C e

arly

chi

ldho

od c

rede

ntia

lW

orki

ng to

war

d N

C e

arly

chi

ldho

od c

rede

ntia

lO

ther

,spe

cify

11f.

Lead

Ass

ista

ntLo

ng-T

erm

Subs

titut

e

Firs

t nam

eLa

st n

ame

Entry

dat

e

NA

Exit

date

NA

Educ

atio

n(C

heck

all

that

app

ly)

MA/

MS

or h

ighe

r deg

ree,

spe

cify

maj

or

Wor

king

tow

ard

MA/

MS

or h

ighe

r deg

ree

BA/B

S de

gree

, spe

cify

maj

or

Wor

king

tow

ard

BA/B

S de

gree

AA/A

AS d

egre

e, s

peci

fy m

ajor

Wor

king

tow

ard

AA/A

AS d

egre

eH

igh

Scho

ol d

iplo

ma/

GED

Less

than

or w

orki

ng to

war

d H

igh

Scho

ol/G

ED

Cer

tific

atio

ns/C

rede

ntia

ls(C

heck

all

that

app

ly)

NC

teac

her's

lice

nse,

spe

cify

are

a

Anot

her s

tate

’s te

ache

r's li

cens

e, s

peci

fy a

rea

Wor

king

tow

ard

teac

her's

lice

nse

B-K

or p

resc

hool

add

-on

licen

sure

Wor

king

tow

ard

B-K

or p

resc

hool

add

-on

licen

sure

CD

A (C

hild

Dev

elop

men

t Ass

ocia

te) c

rede

ntia

lW

orki

ng to

war

d C

DA

cred

entia

lN

C e

arly

chi

ldho

od c

rede

ntia

lW

orki

ng to

war

d N

C e

arly

chi

ldho

od c

rede

ntia

lO

ther

,spe

cify

End

of C

lass

room

For

mC

heck

list:

ü

Mak

e su

re th

at e

very

thin

g is

spe

lled

corre

ctly

ü

Mak

e su

re th

at a

ll fie

lds

are

fille

d ou

t

ü

Prin

t out

the

form

for s

endi

ng to

FPG

ü

Prin

t (or

pho

toco

py) a

cop

y fo

r you

r rec

ords

ü

Bund

le fo

rms

toge

ther

as

expl

aine

d in

Instr

uctio

ns

Lead

Tea

cher

Firs

tan

d La

st N

ame:

26 | More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program 27

(For

offi

ce u

se o

nly)

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_ _

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/200

1-20

02Cn

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teC

lass

room

Child

Year

Child

For

m •

Page

1 o

f 4

M

ore

at F

our R

epor

t

Chi

ld F

orm

22 it

ems

Com

plet

e on

e fo

r ea

chM

ore

at F

our c

hild

Ref

er to

Chi

ld F

orm

Inst

ruct

ions

1.R

epor

ting

date

(mm

/dd/

yyyy

)

2.C

ount

y w

here

Chi

ld a

ttend

s(A

s on

Cla

ssro

om F

orm

)

3.S

ite n

ame

(As

on C

lass

room

For

m)

4.C

lass

room

cod

e(A

s on

Cla

ssro

om F

orm

)

5.Le

ad T

each

er n

ame

6.C

hild

’s fi

rst n

ame

7.C

hild

’s m

iddl

e in

itial

8.C

hild

’s la

st n

ame

9.C

hild

’s d

ate

of b

irth

(mm

/dd/

yyyy

)

10.

Chi

ld’s

iden

tific

atio

n nu

mbe

rs(C

heck

all

boxe

s th

at a

pply

and

fill

in a

ll id

entif

icat

ion

num

bers

ava

ilabl

e fo

r Chi

ld.

Spec

ify ty

pe o

f ID

num

ber i

f Oth

er.)

Soci

al S

ecur

ity n

umbe

r....

......

......

.D

HH

S id

entif

icat

ion

num

ber.

......

....

SIM

S id

entif

icat

ion

num

ber.

......

.....

Oth

er id

entif

icat

ion

num

ber.

......

.....

Spec

ify ty

pe o

f Oth

er ID

num

ber.

....

11.

Chi

ld’s

gen

der

(Che

ck o

ne)

Fem

ale

M

ale

12.

Chi

ld’s

race

(Che

ckal

l tha

t app

ly)

Whi

te o

r Eur

opea

n Am

eric

anBl

ack

or A

frica

n Am

eric

anAm

eric

an In

dian

or A

lask

a N

ativ

eAs

ian

Nat

ive

Haw

aiia

n or

Oth

er P

acific

Isla

nder

Span

ish

/ His

pani

c / L

atin

o

cont

inue

d on

nex

t pag

eC

hild

's F

irst a

ndLa

st N

ame:

Chi

ld's

Firs

t and

(For

offi

ce u

se o

nly)

_ _

/_

_ _

_ /

_ _

_ _

/_

_ _

_ _

/200

1-20

02Cn

tySi

teC

lass

room

Child

Year

Child

For

m •

Page

2 o

f 4

M

ore

at F

our R

epor

t

13.

Chi

ld’s

Mor

e at

Fou

r ris

k cr

iteria

at t

ime

of e

nrol

lmen

t (F

or e

ach

fact

or, c

heck

one

leve

l. M

inor

ity S

tatu

s m

ay b

e “N

A”.)

Fact

orLe

vel 2

Sign

ifica

nt F

acto

rLe

vel 1

Pote

ntia

l Fac

tor

Leve

l 0N

eglig

ible

Impa

ctFa

mily

inco

me

Elig

ible

for f

ree

lunc

hEl

igib

le fo

r red

uced

pric

e lu

nch

Inel

igib

le

Chi

ld’s

heal

th s

tatu

sCh

ildis

iden

tifie

d as

m

enta

lly o

r phy

sica

lly

chro

nica

lly il

l or

med

ical

ly fr

agile

Chi

ld is

see

n or

has

bee

n se

en b

y a

pedi

atric

sp

ecia

list f

or a

chr

onic

he

alth

con

cern

Chi

ld h

as n

o si

gnifi

cant

he

alth

con

cern

s

Iden

tifie

d sp

ecia

l nee

dsC

hild

has

a c

urre

nt

Indi

vidu

aliz

ed E

duca

tion

Prog

ram

(IEP

)

Chi

ld h

as a

n In

divid

ualiz

ed

Fam

ily S

ervic

e Pl

an (I

FSP)

bu

t doe

s no

t qua

lify

for a

n In

divid

ualiz

ed E

duca

tion

Prog

ram

(IEP

)

No

spec

ial n

eeds

iden

tifie

d

Pare

nt e

duca

tion

Mot

her (

or p

rimar

y ca

regi

ver)

does

not

hav

e a

high

sch

ool d

iplo

ma

Mot

her (

or p

rimar

y ca

regi

ver)

has

a G

EDM

othe

r (or

prim

ary

care

give

r) ha

s a

high

sch

ool

diplom

aPa

rent

em

ploy

men

tM

othe

r (or

prim

ary

care

give

r) is

un

empl

oyed

Mot

her (

or p

rimar

y ca

regi

ver)

has

been

em

ploy

ed a

t cur

rent

job

for

less

than

12

mon

ths

Mot

her (

or p

rimar

y ca

regi

ver)

has

been

em

ploy

ed a

t cur

rent

job

for

12 m

onth

s or

mor

eFa

mily

com

posit

ion

Chi

ld li

ves

with

a s

ingl

e pa

rent

and

ther

e ar

e co

mpo

undi

ng fa

ctor

s su

ch a

s pa

rent

al

subs

tanc

e ab

use

or

abus

e/ne

glec

t

Chi

ld li

ves

with

sin

gle

pare

ntC

hild

live

s w

ith tw

o pa

rent

s

Hou

sing

stab

ility

Chi

ld h

as n

o st

able

pl

ace

to li

ve. C

hild

may

be

hom

eles

s

Chi

ld h

as liv

ed a

t mul

tiple

ad

dres

ses

durin

g th

e pr

eced

ing

12 m

onth

s

Chi

ld h

as re

side

d at

the

sam

e ad

dres

s du

ring

the

prec

edin

g 12

mon

ths

Engl

ish

prof

icie

ncy

Fam

ily a

nd c

hild

do

not

spea

k En

glis

hFa

mily

and

chi

ld s

peak

lim

ited

Engl

ishFa

mily

and

chi

ld s

peak

En

glis

hM

inor

ity s

tatu

s

(Che

ckap

prop

riate

leve

l bo

x or

NA)

N

AC

hild

is a

mem

ber o

f a

min

ority

gro

up a

nd

dem

onst

rate

s an

y 4

or

mor

e ris

k fa

ctor

s

Chi

ld is

a m

embe

r of a

m

inor

ity g

roup

and

de

mon

stra

tes

up to

3 ri

sk

fact

ors

Chi

ld is

a m

embe

r of a

m

inor

ity g

roup

and

doe

s no

t de

mon

stra

te a

ny ri

sk fa

ctor

s

14.

Chi

ld’s

Mor

e at

Fou

r Ser

vice

Prio

rity

Stat

us a

t tim

e of

enr

ollm

ent

(Che

ck o

ne. S

peci

fy if

Oth

er)

1C

hild

has

nev

er b

een

serv

ed in

chi

ld c

are

2C

hild

is e

ligib

le fo

r fin

anci

al a

ssis

tanc

e fo

r chi

ld c

are

serv

ices

but

is n

ot re

ceiv

ing

any

assi

stan

ce

3C

hild

is c

urre

ntly

bei

ng s

erve

d in

chi

ld c

are

setti

ng th

at d

oes

not m

eet M

ore

at F

our p

rogr

am

stan

dard

s

4O

ther

,spe

cify

bel

ow

cont

inue

d on

nex

t pag

eC

hild

's F

irst a

nd

Last

Nam

e:

26 More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program | 27

(For

offi

ce u

se o

nly)

_ _

/_

_ _

_ /

_ _

_ _

/_

_ _

_ _

/200

1-20

02Cn

tySi

teC

lass

room

Child

Year

Child

For

m •

Page

3 o

f 4

M

ore

at F

our R

epor

t

15.

Has

Chi

ld p

revi

ousl

y be

en s

erve

d in

a li

cens

ed o

r reg

ulat

ed

child

car

e se

tting

?

(Che

ck o

ne)

No

Yes

16.

Num

ber o

f adu

lts (a

ge 1

8 an

d ol

der)

resi

ding

in C

hild

’s h

ouse

hold

17.

Num

ber o

f chi

ldre

n (u

nder

age

18)

resi

ding

in C

hild

’s h

ouse

hold

18.

Cou

nty

of c

urre

nt h

ouse

hold

resi

denc

e

19.

Dat

e C

hild

enr

olle

d in

Mor

e at

Fou

r:(m

m/d

d/yy

yy)

20.

Dat

e C

hild

with

drew

from

Mor

e at

Fou

r if b

efor

e en

d of

sch

ool

year

: (Che

ck N

A if

Chi

ld is

stil

l enr

olle

d or

ent

er d

ate

as m

m/d

d/yy

yy)

NA

(ski

p to

Item

21)

20a.

If C

hild

with

drew

from

Mor

e at

Fou

r, in

dica

te re

ason

:(C

heck

one

)C

hild

mov

ed o

ut o

f ser

vice

area

Pare

nt c

hoic

eU

nkno

wn

Oth

er(s

peci

fy b

elow

)

21.

Num

ber o

f day

s C

hild

atte

nded

Mor

e at

Fou

r cla

ssro

om e

ach

mon

th(E

nter

a n

umbe

r for

eac

h m

onth

or e

nter

0 if

Chi

ld w

as n

ot e

nrol

led

that

mon

th.)

Janu

ary

2002

atte

ndan

ceFe

brua

ry 2

002

atte

ndan

ceM

arch

200

2at

tend

ance

April

200

2at

tend

ance

May

200

2at

tend

ance

cont

inue

d on

nex

t pag

e

Chi

ld's

Firs

t and

Last

Nam

e:C

hild

's F

irst a

nd

(For

offi

ce u

se o

nly)

_ _

/_

_ _

_ /

_ _

_ _

/_

_ _

_ _

/200

1-20

02Cn

tySi

teC

lass

room

Chi

ldY

ear

Child

For

m •

Page

4 o

f 4

M

ore

at F

our

Rep

ort

22.

Has

this

Chi

ld b

een

refe

rred

for e

valu

atio

n fo

r a

disa

bilit

y?

(Che

ck o

ne. S

peci

fy d

ate

of re

ferr

al if

Yes

)

No

(Ski

p to

end

of F

orm

)

Yes

,prio

r to

Mor

e at

Fou

r ent

ry (s

peci

fy d

ate)

Dat

e of

refe

rral:

Yes

,afte

r Mor

e at

Fou

r ent

ry (s

peci

fy d

ate)

Dat

e of

refe

rral:

22a.

Wha

t was

the

deci

sion

from

the

disa

bilit

y ev

alua

tion

for t

his

Chi

ld?

No

disa

bilit

y id

entif

ied

(Ski

p to

end

of F

orm

)

Eval

uatio

n de

cisi

on in

pro

cess

(Ski

p to

end

of

Form

)O

ne o

r mor

e di

sabi

litie

s id

entif

ied

22b.

Type

of i

dent

ified

dis

abilit

y(ie

s) fo

r thi

s C

hild

(C

heck

all

that

app

ly)

Aut

istic

Dea

f-Blin

dBe

havi

oral

ly/E

mot

iona

lly D

isab

led

Educ

able

Men

tally

Dis

able

dH

earin

g Im

paire

dSp

ecifi

c Le

arni

ng D

isab

led

Mul

ti-ha

ndic

appe

dO

ther

Hea

lth Im

paire

d

Orth

oped

ical

ly Im

paire

dSp

eech

/Lan

guag

e Im

paire

dSe

vere

/Pro

foun

d M

enta

lly D

isab

led

Trai

nabl

e M

enta

lly R

etar

ded

Visu

al Im

paire

dTr

aum

atic

Bra

in In

jure

dPr

esch

ool D

evel

opm

enta

lly D

elay

ed

22c.

Doe

s th

is C

hild

hav

e an

act

ive

IEP?

(C

heck

one

)IE

P=I

ndiv

idua

lized

Edu

catio

n P

lan

No

(Ski

pto

end

of F

orm

)Ye

s

22d.

Has

this

Chi

ld b

een

refe

rred

for s

ervi

ces

rela

ted

to d

isab

ility

?(C

heck

one

)

No

(Ski

p to

end

of F

orm

)

Yes

22e.

Is th

is C

hild

rece

ivin

g se

rvic

es re

late

d to

dis

abili

ty?

(Che

ck o

ne. S

peci

fy ty

pe o

f ser

vice

s if

Yes

)

No

Yes

(Spe

cify

type

of s

ervi

ces)

Type

of s

ervi

ces:

Not

es a

bout

this

Chi

ld F

orm

End

of C

hild

For

m

Che

cklis

t:ü

Mak

e su

re th

at e

very

thin

g is

spe

lled

corre

ctly

ü

Mak

e su

re th

at a

ll fie

lds

are

fille

d ou

t

ü

Prin

t out

the

form

for s

endi

ng to

FPG

ü

Prin

t (or

pho

toco

py) a

cop

y fo

r you

r rec

ords

ü

Bund

le fo

rms

toge

ther

as

expl

aine

d in

Inst

ruct

ions

Chi

ld's

Firs

t and

Last

Nam

e:

28 | More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program 29

Appendix BInstructions for Child- and Program-Specifi c Reporting Forms for Spring 2002

28 More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program | 29

Mor

e at

Fou

r Spr

ing

2002

/ Ye

ar 1

Rep

ort I

nstru

ctio

ns

Gen

eral

Inst

ruct

ions

� Pa

ge 1

of 3

Gen

eral

Inst

ruct

ions

and

Info

rmat

ion

I.Th

is p

acke

t con

tain

s re

quire

d M

ore

at F

our R

epor

t For

ms

and

Form

s In

stru

ctio

ns.

You

as th

e Pr

ogra

m C

onta

ct a

re re

spon

sibl

e fo

r mak

ing

sure

that

all

nece

ssar

y fo

rms

are

com

plet

ely

fille

d ou

t, co

mpi

ling

the

info

rmat

ion,

bun

dlin

g al

l prin

ted

form

s to

geth

er, a

nd s

endi

ng th

e bu

ndle

to th

e FP

G

Chi

ld D

evel

opm

ent I

nstit

ute.

II.

Ther

e ar

e fo

ur le

vels

of R

epor

t For

ms,

and

they

cap

ture

des

crip

tive

and

serv

ice

info

rmat

ion.

Thes

e Ye

ar 1

repo

rts w

ill ca

ptur

e de

scrip

tive

info

rmat

ion

AND

ser

vice

info

rmat

ion

thro

ugh

May

200

2.

This

app

lies

to a

ll fo

ur le

vels

of r

epor

t for

ms.

Eac

h M

ore

at F

our g

rant

pro

gram

is re

quire

d to

sub

mit:

��

one

(1) c

ompl

eted

Con

tract

Ad

min

istra

tor F

orm

(1 p

age,

6 it

ems)

��

as m

any

com

plet

ed S

ite F

orm

s as

th

ere

are

Mor

e at

Fou

r Site

s

(2 p

ages

, 11

item

s)

��

as m

any

com

plet

ed C

lass

room

Fo

rms

as

ther

e ar

e M

ore

at F

our

Cla

ssro

oms

(3

pag

es, 1

1 ite

ms)

��

as m

any

com

plet

ed C

hild

For

ms

as

ther

e ar

e M

ore

at F

our C

hild

ren

(4

pag

es, 2

2 ite

ms)

A d

iagr

am s

how

ing

how

to b

undl

e th

e co

mpl

eted

pape

r for

ms

for r

etur

n is

pro

vide

d la

ter i

n th

ese

inst

ruct

ions

.

III.

Def

initi

ons

of R

epor

ting

Leve

ls

Con

trac

t Adm

inis

trat

or is

the

unit

that

adm

inis

ters

the

Mor

e at

Fou

r pro

gram

at t

he c

ount

y or

regi

on

leve

l (fo

r exa

mpl

e, P

erso

n C

ount

y, o

r Reg

ion

A).

Site

is a

ser

vice

-leve

l set

ting

that

hos

ts th

e M

ore

at F

our c

lass

room

(s),

for e

xam

ple,

a c

hild

car

e fa

cilit

y,

loca

l sch

ool,

or H

ead

Star

t cen

ter.

A si

te m

ay b

e pa

rt of

a la

rger

age

ncy

such

as

a pu

blic

sch

ool d

istri

ct.

Cla

ssro

om is

a c

lass

room

whe

re o

ne o

r mor

e M

ore

at F

our c

hild

ren

are

enro

lled.

Chi

ld is

any

chi

ld w

ho is

enr

olle

d in

Mor

e at

Fou

r.

IV.

Ther

e ar

e m

ultip

le w

ays

to g

et th

e fo

rms

and

inst

ruct

ions

.(1

) As

emai

l atta

chm

ents

. Sav

e th

e em

ail a

ttach

men

ts (e

lect

roni

c fil

es o

f bla

nk c

opie

s of

the

four

diff

eren

t fo

rms

and

corre

spon

ding

inst

ruct

ions

) ont

o yo

ur c

ompu

ter.

(2) D

ownl

oad

from

the

Web

. You

may

dow

nloa

d el

ectro

nic

files

of b

lank

cop

ies

of th

e fo

ur d

iffer

ent f

orm

s an

d co

rresp

ondi

ngin

stru

ctio

ns fr

om th

is W

eb s

ite: w

ww

.fpg.

unc.

edu/

~maf

eval

/. Yo

u ca

n th

en s

ave

the

files

ont

o yo

ur c

ompu

ter.

(3) I

n th

e FP

G m

ailin

g. Y

ou m

ay w

ait f

or th

e m

ailin

g fro

m th

e M

ore

at F

our E

valu

atio

n Te

am a

t the

FPG

C

hild

Dev

elop

men

t Ins

titut

e an

d m

ake

phot

ocop

ies

of th

e in

clud

ed p

aper

ver

sion

s of

the

form

s an

d in

stru

ctio

ns. T

his

pack

et w

ill al

so c

onta

in a

CD

with

the

elec

troni

c ve

rsio

n al

l of t

he fo

rms

and

inst

ruct

ions

(use

this

CD

if y

ou w

ere

unab

le to

get

the

emai

l atta

chm

ents

or d

ownl

oad

from

the

Web

).

Gen

eral

Inst

ruct

ions

� Pa

ge 2

of 3

V.

Fill

out t

he fo

rms

eith

er o

n th

e co

mpu

ter (

reco

mm

ende

d) o

r with

pen

on

pape

r.W

ith e

ither

met

hod,

you

are

to re

turn

the

com

plet

ed s

et o

f for

ms,

in p

aper

cop

ies

only

, to

the

FPG

Mor

e at

Fou

r Eva

luat

ion

Team

.

Met

hod

A) (r

ecom

men

ded)

Fill

out t

he fo

rms

on y

our c

ompu

ter a

nd p

rint e

ach

one

out.

We

enco

urag

e yo

u to

use

this

met

hod.

To fi

ll ou

t the

form

s on

you

r com

pute

r, yo

u m

ust h

ave

the

Adob

e Ac

roba

t Rea

der p

rogr

am* (

vers

ion

3.0

or h

ighe

r) an

d th

e fo

ur fo

rm fi

les.

Ope

n th

e fir

st fi

le th

at y

ou w

ant t

o w

ork

on. T

ype

in y

our r

espo

nse

to

each

bla

nk o

r che

ck th

e ap

prop

riate

box

. Use

the

Tab

key

or c

lick

with

the

mou

se to

mov

e to

the

next

bl

ank.

Afte

r filli

ng o

ut th

e en

tire

form

, prin

t it.

Plea

se s

tapl

e m

ulti-

page

form

s. C

lose

the

file.

(War

ning

: The

Acr

obat

Rea

der d

oes

not a

llow

you

to s

ave

your

fille

d in

form

.)

To p

roce

ed, o

pen

anot

her b

lank

form

, typ

e in

resp

onse

s, p

rint t

he fo

rm, a

nd s

tapl

e th

e pa

ges

toge

ther

. Yo

u on

ly n

eed

to c

ompl

ete

one

Con

tract

Adm

inis

trato

r For

m, b

ut y

ou�ll

(pro

babl

y) n

eed

mul

tiple

Site

, C

lass

room

, and

Chi

ld F

orm

s.

* The

free

Ado

be A

crob

at R

eade

r pro

gram

is a

vaila

ble

from

the

Adob

e w

eb s

ite:

http

://w

ww

.ado

be.c

om/p

rodu

cts/

acro

bat/r

eads

tep.

htm

l

or

Met

hod

B) F

ill ou

t the

form

s w

ith p

en o

n pa

per.

If yo

u ch

oose

this

met

hod,

prin

t out

and

/or m

ake

as

man

y ph

otoc

opie

s of

eac

h fo

rm a

s yo

u ne

ed fo

r you

r Mor

e at

Fou

r pro

gram

gra

nt (o

r con

tact

the

FPG

M

ore

at F

our E

valu

atio

n Te

am to

requ

est c

opie

s). M

ake

sure

that

resp

onse

s ar

e le

gibl

e an

d th

e m

arks

ar

e cl

ear.

VI.

Follo

w th

ese

guid

elin

es fo

r eac

h fo

rm.

Reg

ardl

ess

of w

hich

met

hod

you

choo

se to

fill

out f

orm

s, n

ote:

��

ALL

field

s of

all

form

s m

ust b

e fil

led

out.

Do

not l

eave

any

of t

he q

uest

ions

una

nsw

ered

unl

ess

you

are

aske

d to

ski

p to

a la

ter i

tem

(�sk

ip to

Item

21,

� for

exa

mpl

e). T

hen

you

may

leav

e th

e sk

ippe

d ite

ms

unan

swer

ed. C

heck

NA

if a

ques

tion

is n

ot a

pplic

able

.

��

Mar

k on

ly in

the

boxe

s an

d bl

anks

pro

vide

d. D

o no

t writ

e in

the

mar

gins

of t

he p

aper

-- th

ese

mar

ks

will

not b

e pr

oces

sed.

The

re is

a s

pace

to ty

pe in

Not

es in

the

Chi

ld F

orm

.

��

Mak

e su

re a

ll pa

ges

of m

ulti-

page

form

s ar

e st

aple

d to

geth

er. B

ecau

se e

very

pro

gram

is fi

lling

out

thes

e sa

me

form

s, it

is im

porta

nt th

at a

ll pa

ges

of m

ulti-

page

form

s st

ay to

geth

er.

VII

. Th

ere

may

be

mor

e th

an o

ne w

ay o

f get

ting

the

requ

ired

info

rmat

ion.

The

info

rmat

ion

may

be

hous

ed a

t you

r Mor

e at

Fou

r con

tract

adm

inis

trato

r site

and

/or a

t you

r sc

hool

/chi

ld c

are

site

s. Y

ou a

s th

e Pr

ogra

m C

onta

ct m

ay h

ave

the

info

rmat

ion

you

need

to c

ompl

ete

all

four

leve

ls o

f the

se re

port

form

s. O

r you

may

dis

tribu

te re

port

form

s to

be

com

plet

ed b

y th

e M

ore

at F

our

site

(s) a

nd/o

r cla

ssro

om(s

) in

your

cou

nty/

regi

on. O

r you

mig

ht c

olle

ct th

e in

form

atio

n an

othe

r way

.

VII

I. B

undl

e th

e co

mpl

eted

form

s as

des

crib

ed.

The

diag

ram

on

the

next

pag

e di

spla

ys h

ow th

e fo

rms

shou

ld b

e bu

ndle

d (e

ach

Mor

e at

Fou

r gra

nt

prog

ram

has

one

Con

tract

Adm

inis

trato

r, bu

t gra

nt p

rogr

ams

have

diff

eren

t num

bers

of S

ites,

C

lass

room

s, a

nd C

hild

ren)

.

��Pu

t all

com

plet

ed C

hild

For

ms

from

one

cla

ssro

om to

geth

er.

A co

mpl

eted

Cla

ssro

om F

orm

goe

s on

top

of th

ese

to m

ake

a C

lass

room

Rep

ort s

tack

.

��Pu

t all

Cla

ssro

om R

epor

t sta

cks

from

one

site

toge

ther

.

A co

mpl

eted

Site

For

m g

oes

on to

p of

thes

e to

mak

e a

Site

Rep

ort s

tack

.

��Pu

t all

Site

Rep

ort s

tack

s to

geth

er. T

he c

ompl

eted

Con

tract

Adm

inis

trato

r For

m g

oes

on to

p.

��Yo

u w

ill se

nd th

is e

ntire

bun

dle

to th

e FP

G M

ore

at F

our E

valu

atio

n Te

am.

30 | More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program 31

Gen

eral

Inst

ruct

ions

� Pa

ge 3

of 3

IX.

All f

orm

s ar

e du

e to

the

FPG

Mor

e at

Fou

r Eva

luat

ion

Team

by

June

5th

200

2.

Afte

r com

plet

ing

and

prin

ting

all f

orm

s, p

lace

them

in a

n ap

prop

riate

ly-s

ized

env

elop

e or

box

, atta

ch th

e pr

e-pa

id, p

re-a

ddre

ssed

UPS

mai

ler l

abel

pro

vide

d fo

r you

by

FPG

, and

arra

nge

for a

UPS

pic

kup.

You

m

ust s

end

by T

uesd

ay J

une

4, 2

002

in o

rder

to m

eet t

he J

une

5th

dead

line.

X.

FPG

Mor

e at

Fou

r Eva

luat

ion

Team

con

tact

info

rmat

ion:

Ph

one

num

ber:

919-

843-

3671

(cal

l col

lect

)

Emai

l add

ress

: m

afev

al@

unc.

edu

Web

site

: w

ww

.fpg.

unc.

edu/

~maf

eval

Prog

ram

Con

tact

s m

ay c

onta

ct th

e FP

G M

ore

at F

our E

valu

atio

n Te

am w

ith a

ny q

uest

ions

. Ple

ase

have

Si

tes,

Cla

ssro

oms,

and

Tea

cher

s co

mm

unic

ate

with

thei

r loc

al M

ore

at F

our P

rogr

am C

onta

ct.

The

~ til

de s

ymbo

l is

usua

lly lo

cate

d on

the

left

side

of t

he to

p ro

w o

f you

r key

boar

d

Mor

e at

Fou

r Spr

ing

2002

/ Ye

ar 1

Rep

ort I

nstru

ctio

ns

Con

tract

Adm

inis

trato

r For

m In

stru

ctio

ns �

Page

1 o

f 1

Con

trac

t Adm

inis

trat

or F

orm

Spe

cific

Inst

ruct

ions

Com

plet

e one

Con

tract

Adm

inis

trato

r For

m fo

r you

r cou

nty/

regi

on. A

nsw

er a

ll 6

item

s in

this

1-p

age

form

.

1.R

epor

ting

date

� En

ter t

he d

ate

that

the

Con

tract

Adm

inis

trato

r For

m w

as c

ompl

eted

(for

mat

ted

as

mm

/dd/

yyyy

).

2.M

ore

at F

our c

ount

y or

regi

on �

Ente

r the

cou

nty

or re

gion

whe

re th

is M

ore

at F

our g

rant

pro

gram

is

adm

inis

tere

d.

Ex: D

ogw

ood

Cou

nty

Ex

: Reg

ion

A

3.

Adm

inis

trat

ive

agen

cy fo

r Mor

e at

Fou

r con

trac

t � E

nter

the

nam

e of

the

agen

cy h

andl

ing

the

Mor

e at

Fo

ur g

rant

pro

gram

-- u

sual

ly a

sch

ool d

istri

ct o

r a S

mar

t Sta

rt pa

rtner

ship

.

Ex: D

ogwo

od C

ount

y Sc

hool

Dis

tric

t

4.

Mor

e at

Fou

r pro

gram

con

tact

nam

e � E

nter

the

nam

e of

the

prog

ram

con

tact

per

son

for t

his

Mor

e at

Fou

r gr

ant.

This

is th

e pe

rson

who

is re

spon

sibl

e fo

r com

plet

ing

the

repo

rt fo

rms .

Ex: C

hris

Car

dina

l

5.

Mor

e at

Fou

r pro

gram

con

tact

pho

ne n

umbe

r � E

nter

the

phon

e nu

mbe

r for

the

prog

ram

con

tact

per

son

(incl

ude

the

area

cod

e).

6.N

umbe

r of M

ore

at F

our s

lots

allo

cate

d fo

r thi

s gr

ant b

y m

onth

� En

ter t

he n

umbe

r of s

lots

allo

cate

d fo

r M

ore

at F

our c

hild

ren

for t

his

gran

t for

eac

h m

onth

thro

ugh

May

200

2. T

he n

umbe

r of s

lots

allo

cate

d m

ight

be

the

sam

e fo

r all

mon

ths.

30 More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program | 31

Mor

e at

Fou

r Spr

ing

2002

/ Ye

ar 1

Rep

ort I

nstru

ctio

ns

Site

For

m In

stru

ctio

ns �

Page

1 o

f 2

Site

For

m S

peci

fic In

stru

ctio

ns

Com

plet

e on

e Si

te F

orm

for each

Mor

e at

Fou

r site

in y

our c

ount

y/re

gion

. Ans

wer

all

11 it

ems

in th

is 2

-pag

e fo

rm.

1.

Rep

ortin

g da

te �

Ente

r the

dat

e th

at th

e Si

te F

orm

was

com

plet

ed (f

orm

atte

d as

mm

/dd/

yyyy

).

2.

Cou

nty

whe

re M

ore

at F

our S

ite is

loca

ted

�

Ex: D

ogwo

od C

ount

y

3.

Mor

e at

Fou

r Site

nam

e �

Ex

: Dog

wood

Ele

men

tary

Sch

ool

4.

Type

of a

genc

y th

is S

ite is

par

t of �

Che

ck th

e bo

x ne

xt to

the

type

of a

genc

y th

at th

is S

ite is

par

t of,

and

then

fill

in th

e na

me

of th

e ag

ency

.

5.

Mor

e at

Fou

r Site

Dire

ctor

/Prin

cipa

l nam

e � E

nter

the

nam

e of

the

Site

Dire

ctor

or P

rinci

pal.

Ex: P

at E

mer

ald

6.

Dire

ctor

/Prin

cipa

l pho

ne n

umbe

r � E

nter

the

phon

e nu

mbe

r for

the

Prin

cipa

l/Dire

ctor

(inc

lude

the

area

co

de).

7.

Dire

ctor

/Prin

cipa

l Edu

catio

n an

d C

rede

ntia

ls/C

ertif

icat

ion

info

rmat

ion

� For

bot

h Ed

ucat

ion

and

Cer

tific

atio

ns/C

rede

ntia

ls, c

heck

all

that

app

ly a

nd fi

ll in

whe

re re

ques

ted.

Site

For

m In

stru

ctio

ns �

Page

2 o

f 2

8.N

umbe

r of o

pera

tion

days

for t

his

site

eac

h m

onth

� Fo

r eac

h m

onth

, Jan

uary

thro

ugh

June

200

2, c

heck

th

e bo

x ne

xt to

eac

h da

y th

at th

is s

ite w

as in

ope

ratio

n se

rvin

g ch

ildre

n. D

o no

t che

ck a

box

if th

e si

te w

as

not s

ervi

ng a

ny c

hild

ren

that

day

(for

exa

mpl

e, d

o no

t che

ck b

ox fo

r a te

ache

r wor

kday

).

9.

Dat

es o

f tea

cher

wor

kday

s at

this

site

by

mon

th �

Ente

r all

date

s of

teac

her w

orkd

ays

Janu

ary

2002

th

roug

h Ju

ne 2

002

(form

atte

d as

mm

/dd/

yyyy

).

10.

End

date

of M

ore

at F

our s

ervi

ces

� Ent

er th

e da

te o

f the

last

day

that

this

site

will

be/w

as in

ope

ratio

n se

rvin

g ch

ildre

n fo

r the

Mor

e at

Fou

r pro

gram

this

yea

r (fo

rmat

ted

as m

m/d

d/yy

yy).

11.N

umbe

r of M

ore

at F

our s

lots

allo

cate

d fo

r thi

s si

te e

ach

mon

th �

Ente

r the

num

ber o

f slo

ts a

lloca

ted

for M

ore

at F

our c

hild

ren

at th

is s

ite e

ach

mon

th th

roug

h M

ay 2

002.

The

num

ber o

f slo

ts a

lloca

ted

mig

ht b

e th

e sa

me

for a

ll m

onth

s.

�If

you

fill o

ut th

is fo

rm w

ith p

en to

pap

er, y

ou w

ill ne

ed to

writ

e th

e Si

te N

ame

on th

e bo

ttom

of t

he s

econ

d pa

ge (t

his

will

be d

one

auto

mat

ical

ly if

you

fill

out t

he fo

rm u

sing

Ado

be A

crob

at).

32 | More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program 33

Mor

e at

Fou

r Spr

ing

2002

/ Ye

ar 1

Rep

ort I

nstru

ctio

ns

Cla

ssro

om F

orm

Inst

ruct

ions

� Pa

ge 1

of 2

Cla

ssro

om F

orm

Spe

cific

Inst

ruct

ions

Com

plet

e on

e C

lass

room

For

m fo

r eac

hM

ore

at F

our c

lass

room

in e

ach

Site

. Ans

wer

all

11 it

ems

in th

is 3

-pa

ge fo

rm.

1.

Rep

ortin

g da

te �

Ente

r the

dat

e th

at th

e C

lass

room

For

m w

as c

ompl

eted

(for

mat

ted

as m

m/d

d/yy

yy).

2.C

ount

y w

here

Cla

ssro

om is

loca

ted

� Ent

er th

e co

unty

whe

re th

is C

lass

room

is lo

cate

d.

Exam

ple:

Dog

wood

Cou

nty

3.Si

te n

ame

� Ent

er th

e Si

te n

ame

that

this

Cla

ssro

om is

par

t of (

sam

e as

Item

3 o

f Site

Rep

ort F

orm

).

Ex: D

ogwo

od E

lem

enta

ry S

choo

l

4.

Type

of c

lass

room

ser

ving

Mor

e at

Fou

r chi

ldre

n � C

heck

all

that

app

ly. I

f the

ans

wer

is �O

ther

�, sp

ecify

.

5.

Cla

ssro

om c

ode

� Eac

h cl

assr

oom

sho

uld

be a

ssig

ned

a tw

o-di

git c

lass

room

cod

e to

dis

tingu

ish

it fro

m

othe

r cla

ssro

oms

in th

e sa

me

Site

. Thi

s co

de c

an b

e as

sign

ed b

y th

e M

ore

at F

our P

rogr

am C

onta

ct o

r by

som

eone

at t

he S

ite le

vel.

The

clas

sroo

m c

ode

is re

ques

ted

on th

e co

rresp

ondi

ng C

hild

Rep

ort F

orm

(s).

Fo

r eac

h si

te, s

tart

with

�01�

and

con

tinue

ass

igni

ng c

odes

for e

ach

clas

sroo

m a

t tha

t site

.

Ex: A

t Dog

woo

d El

emen

tary

Sch

ool,

the

first

cla

ssro

om is

ass

igne

d co

de �0

1.� T

he n

ext c

lass

room

s w

ould

be

cod

ed �0

2�, �

03�,

etc.

At

Mag

nolia

Chi

ld C

are

Cen

ter,

the

first

cla

ssro

om is

ass

igne

d co

de �0

1� a

nd t

he n

ext c

lass

room

s w

ould

be

code

d �0

2�, �

03�,

etc.

6.

Dat

e th

at fi

rst M

ore

at F

our c

hild

enr

olle

d � E

nter

the

first

dat

e th

at th

is c

lass

room

beg

an s

ervi

ng M

ore

at

Four

chi

ldre

n (fo

rmat

ted

as m

m/d

d/yy

yy).

7.

Mor

e at

Fou

r cla

ssro

om s

tart

tim

e � E

nter

the

time

of d

ay th

at th

e M

ore

at F

our c

lass

room

sta

rts (i

f it

star

ts a

t a d

iffer

ent t

ime

on d

iffer

ent d

ays,

ent

er th

e tim

e th

at it

usu

ally

sta

rts).

This

sta

rt tim

e m

ight

be

the

sam

e tim

e th

at n

on-M

ore

at F

our c

lass

room

s st

art.

Ex

: 7:3

0 a.

m.

8.

Mor

e at

Fou

r cla

ssro

om e

nd ti

me

� Ent

er th

e tim

e of

day

that

the

Mor

e at

Fou

r cla

ssro

om e

nds/

dism

isse

s (if

it e

nds

at a

diff

eren

t tim

e on

diff

eren

t day

s, e

nter

the

time

that

it u

sual

ly e

nds)

. Thi

s en

d tim

e m

ight

be

the

sam

e tim

e th

at n

on-M

ore

at F

our c

lass

room

s en

d.

Ex

: 5:3

0 p.

m.

9.

Cla

ss s

ize

(slo

ts fi

lled)

by

mon

th, i

nclu

ding

Mor

e at

Fou

r and

non

-Mor

e at

Fou

r chi

ldre

n � E

nter

the

clas

s si

ze fo

r thi

s cl

assr

oom

for e

ach

mon

th th

roug

h M

ay 2

002.

Thi

s ite

m is

cou

ntin

g sl

ots,

not

spe

cific

ch

ildre

n. F

or n

on-M

ore

at F

our c

hild

ren,

if tw

o pa

rt-tim

e ch

ildre

n sh

are

one

slot

, cou

nt th

is a

s on

e sl

ot fo

r cl

ass

size

. The

cla

ss s

ize

mig

ht b

e th

e sa

me

for a

ll m

onth

s. In

the

follo

win

g ex

ampl

e, th

e cl

ass

size

was

16

in J

anua

ry, F

ebru

ary

and

Mar

ch, a

nd th

en 1

5 in

Apr

il an

d M

ay.

Cla

ssro

om F

orm

Inst

ruct

ions

� Pa

ge 2

of 2

10. N

umbe

r of M

ore

at F

our s

lots

allocated

for t

his

clas

sroo

m e

ach

mon

th �

Ente

r the

num

ber o

f slo

ts

allo

cate

d fo

r Mor

e at

Fou

r chi

ldre

n at

this

site

eac

h m

onth

thro

ugh

May

200

2. T

he n

umbe

r of s

lots

allo

cate

d m

ight

be

the

sam

e fo

r all

mon

ths.

11. M

ore

at F

our T

each

ers

� Ent

er in

form

atio

n fo

r eac

h te

ache

r who

ser

ves

Mor

e at

Fou

r chi

ldre

n. E

nter

in

form

atio

n ab

out t

he c

urre

nt L

ead

Teac

her f

irst.

Ther

e ar

e en

ough

bla

nk ro

ws

to e

nter

info

rmat

ion

for u

p to

fiv

e m

ore

teac

hers

; fill

in o

nly

as m

any

as y

ou n

eed.

For

eac

h :

In

dica

te w

heth

er te

ache

r is

Lead

, Ass

ista

nt, o

r Lon

g-Te

rm S

ubst

itute

;

(Lon

g-Te

rm S

ubst

itute

= te

ache

r who

sub

stitu

ted

for a

t lea

st 1

mon

th);

En

ter t

he te

ache

r�s fi

rst n

ame

and

last

nam

e;

En

ter t

he te

ache

r�s e

ntry

dat

e IF

the

teac

her b

egan

wor

king

in th

is c

lass

room

afte

r the

Mor

e at

Fou

r cl

assr

oom

sta

rted.

Che

ck N

A if

the

teac

her w

as te

achi

ng a

t the

sta

rt of

the

Mor

e at

Fou

r cla

ssro

om;

En

ter t

he te

ache

r�s e

xit d

ate

IF th

e te

ache

r lef

t bef

ore

the

end

of th

e sc

hool

yea

r. C

heck

NA

if th

e te

ache

r ha

s no

t lef

t (is

stil

l tea

chin

g or

taug

ht th

roug

h M

ay 2

002)

.;

Pr

ovid

e Ed

ucat

ion

and

Cer

tific

atio

n/C

rede

ntia

ls fo

r thi

s te

ache

r. C

heck

all

that

app

ly a

nd fi

ll in

whe

re

requ

este

d.

Note:

If a

Mor

e at

Fou

r cla

ssro

om h

as m

ore

than

six

teac

hers

this

yea

r, pl

ease

con

tact

the

FPG

Mor

e at

Fo

ur E

valu

atio

n Te

am v

ia e

mai

l or p

hone

.

�If

you

fill o

ut th

is fo

rm w

ith p

en to

pap

er, y

ou w

ill ne

ed to

writ

e th

e Le

ad T

each

er N

ame

on th

e bo

ttom

of t

he

seco

nd a

nd th

ird p

ages

(thi

s w

ill be

don

e au

tom

atic

ally

if y

ou fi

ll ou

t the

form

usi

ng A

dobe

Acr

obat

).

32 More at Four Evaluation Team - FPG Child Development Institute Child and Program Characteristics of the North Carolina More at Four Pre-kindergarten Program | 33

Mor

e at

Fou

r Spr

ing

2002

/ Ye

ar 1

Rep

ort I

nstru

ctio

ns

Chi

ld F

orm

Inst

ruct

ions

� Pa

ge 1

of 4

Chi

ld F

orm

Spe

cific

Inst

ruct

ions

Com

plet

e on

e C

hild

For

m fo

r each

Mor

e at

Fou

r Chi

ld s

erve

d. A

nsw

er a

ll 22

item

s in

this

4-p

age

form

.

1.

Rep

ortin

g da

te �

Ente

r the

dat

e th

at th

e C

hild

For

m w

as c

ompl

eted

(for

mat

ted

as m

m/d

d/yy

yy).

Exam

ple:

5/1

6/20

02

2.

Cou

nty

whe

re C

hild

atte

nds

� Ent

er th

e co

unty

whe

re th

e C

hild

rece

ives

Mor

e at

Fou

r ser

vice

s.

Ex: D

ogwo

od C

ount

y

3.Si

te n

ame

� Ent

er th

e Si

te n

ame

that

this

Chi

ld is

par

t of (

sam

e as

Item

3 o

f Cla

ssro

om F

orm

).

Ex: D

ogwo

od E

lem

enta

ry S

choo

l

4.C

lass

room

cod

e � E

nter

the

Cla

ssro

om c

ode

for t

he c

lass

room

that

this

Chi

ld is

par

t of (

sam

e as

Item

5 o

f C

lass

room

For

m).

Ex: 0

1

5.

Lead

teac

her n

ame

� Ent

er th

e fir

st n

ame

and

last

nam

e of

the

curre

nt L

ead

Teac

her f

or th

e cl

assr

oom

that

th

is C

hild

is p

art o

f (sa

me

as L

ead

Teac

her i

n Ite

m 1

1 of

Cla

ssro

om F

orm

).

Ex: M

arta

Bas

s

6.

Chi

ld�s

firs

t nam

e � E

nter

the

Chi

ld�s

firs

t nam

e.

Ex: R

ose

7.

Chi

ld�s

mid

dle

initi

al �

Ente

r the

Chi

ld�s

mid

dle

initi

al (o

ne le

tter o

nly,

no

perio

d).

Ex: B

8.

Chi

ld�s

last

nam

e � E

nter

the

Chi

ld�s

last

nam

e.

Ex: E

lmwo

od

9.

Chi

ld�s

dat

e of

birt

h � E

nter

the

Chi

ld�s

dat

e of

birt

h (fo

rmat

ted

as m

m/d

d/yy

yy).

Exam

ple:

10/

19/1

997

10. C

hild

�s id

entif

icat

ion

num

bers

� C

heck

box

to in

dica

te w

hat t

ype

of id

entif

icat

ion

num

ber C

hild

has

and

en

ter i

dent

ifica

tion

num

ber.

Che

ck a

ll bo

xes

that

app

ly a

nd fi

ll in

as

man

y id

entif

icat

ion

num

bers

as

Chi

ld

has.

DH

HS

iden

tific

atio

n nu

mbe

r is

assi

gned

for t

he E

arly

Inte

rven

tion

syst

em. S

IMS

iden

tific

atio

n nu

mbe

r is

ass

igne

d fo

r Dep

artm

ent o

f Pub

lic In

stru

ctio

n (D

PI) p

urpo

ses.

11. C

hild

�s g

ende

r � C

heck

one

box

to in

dica

te C

hild

�s g

ende

r or s

ex.

Ex

: � M

ale

� F

emal

e

12. C

hild

�s ra

ce �

Che

ck a

ll th

at a

pply

to in

dica

te C

hild

�s ra

ce.

(The

se a

re ra

ce c

ateg

orie

s as

they

app

ear o

n th

e U

S ce

nsus

.)

Chi

ld F

orm

Inst

ruct

ions

� Pa

ge 2

of 4

13. C

hild

�s M

ore

at F

our r

isk

crite

ria a

t tim

e of

enr

ollm

ent �

The

risk

crite

ria a

re b

ased

on

the

Mor

e at

Fou

r Pro

gram

Gui

delin

es. C

heck

one

of t

he th

ree

risk

leve

ls fo

r th

is c

hild

for e

ach

Mor

e at

Fou

r ris

k fa

ctor

(for

exa

mpl

e, fa

mily

inco

me,

Chi

ld�s

hea

lth s

tatu

s). C

heck

ON

E ris

k le

vel b

ox fo

r EAC

H fa

ctor

� d

o no

t lea

ve a

ny fa

ctor

s bl

ank.

Not

e th

at M

inor

ity S

tatu

s is

a ri

sk fa

ctor

that

m

ay b

e �N

A� a

nd h

as th

is o

ptio

n bo

x.

14. C

hild

�s M

ore

at F

our S

ervi

ce P

riorit

y St

atus

at t

ime

of e

nrol

lmen

t � T

hese

ser

vice

prio

rity

cate

gorie

s ar

e ba

sed

on th

e M

ore

at F

our P

rogr

am G

uide

lines

. Che

ck o

ne o

f the

Mor

e at

Fou

r ser

vice

prio

rity

stat

us

indi

cato

rs fo

r thi

s C

hild

. If O

ther

, spe

cify

.

15. H

as C

hild

pre

viou

sly

been

ser

ved

in a

lice

nsed

or r

egul

ated

chi

ld c

are

setti

ng?

� Che

ck o

ne b

ox to

in

dica

te w

heth

er o

r not

this

Chi

ld h

as e

ver b

een

serv

ed in

a li

cens

ed o

r reg

ulat

ed c

hild

car

e se

tting

sin

ce b

irth.

Ex

: �N

o�

Yes

16. N

umbe

r of a

dults

(age

18

and

olde

r) re

sidi

ng in

Chi

ld�s

hou

seho

ld �

Ente

r num

ber o

f adu

lts (a

ge 1

8 ye

ars

and

olde

r) w

ho re

side

in th

is C

hild

�s h

ouse

hold

. Ex

: 3

17. N

umbe

r of c

hild

ren

(und

er a

ge 1

8) re

sidi

ng in

Chi

ld�s

hou

seho

ld �

Ente

r num

ber o

f chi

ldre

n (u

nder

age

18

yea

rs) w

ho re

side

in th

is C

hild

�s h

ouse

hold

incl

udin

g th

is M

ore

at F

our-e

ligib

le C

hild

. Ex

: 2

18. C

ount

y of

cur

rent

hou

seho

ld re

side

nce

� Ent

er n

ame

of c

ount

y in

whi

ch th

is C

hild

�s h

ouse

hold

is

curre

ntly

loca

ted.

Ex

: Dog

wood

34 | More at Four Evaluation Team - FPG Child Development Institute

Chi

ld F

orm

Inst

ruct

ions

� P

age

4 of

4

22c.

Doe

s th

is C

hild

hav

e an

act

ive

IEP?

� C

heck

one

box

to in

dica

te w

heth

er o

r not

this

Chi

ld h

as a

n ac

tive

IEP

(Ind

ivid

ualiz

ed E

duca

tion

Pla

n).

If N

o, s

kip

to th

e en

d of

the

form

.

22d.

Has

this

Chi

ld b

een

refe

rred

for s

ervi

ces

rela

ted

to d

isab

ility

? � C

heck

one

box

to in

dica

te w

heth

er o

r no

t thi

s C

hild

has

bee

n re

ferr

ed fo

r ser

vice

s re

late

d to

her

/his

iden

tifie

d di

sabi

lity.

If N

o, s

kip

to th

e en

d of

th

e fo

rm.

22e.

Is C

hild

rece

ivin

g se

rvic

es re

late

d to

dis

abili

ty?

� Che

ck o

ne b

ox to

indi

cate

whe

ther

or n

ot th

is C

hild

ha

s re

ceiv

ed s

ervi

ces

rela

ted

to h

er/h

is id

entif

ied

disa

bilit

y. If

ser

vice

s ha

ve b

een

rece

ived

, spe

cify

type

of

serv

ice(

s) if

kno

wn.

Not

es a

bout

this

Chi

ld F

orm

� If

nec

essa

ry, w

rite

in a

ny n

otes

abo

ut th

is C

hild

For

m h

ere

(rem

embe

r tha

t th

ere

shou

ld b

e no

mar

ks a

nyw

here

on

the

form

exc

ept i

n th

e re

spon

se b

oxes

).

�If

you

fill o

ut th

is fo

rm w

ith p

en to

pap

er, y

ou w

ill n

eed

to w

rite

the

Chi

ld�s

Nam

e on

the

botto

m o

f the

sec

ond,

th

ird a

nd fo

urth

pag

es (t

his

will

be

done

aut

omat

ical

ly if

you

fill

out t

he fo

rm u

sing

Ado

be A

crob

at).

Chi

ld F

orm

Inst

ruct

ions

� Pa

ge 3

of 4

19.

Dat

e C

hild

enr

olle

d in

Mor

e at

Fou

r � E

nter

the

date

that

this

Chi

ld e

nrol

led

in th

e M

ore

at F

our c

lass

room

(fo

rmat

ted

as m

m/d

d/yy

yy).

Ex: 3

/15/

2002

20.

Dat

e C

hild

with

drew

from

Mor

e at

Fou

r if b

efor

e en

d of

sch

ool y

ear

� Ent

er th

e da

te th

at th

is C

hild

w

ithdr

ew fr

om th

e M

ore

at F

our c

lass

room

(for

mat

ted

as m

m/d

d/yy

yy) i

f dat

e is

bef

ore

the

end

of th

e sc

hool

ye

ar.

If C

hild

is a

bsen

t for

a p

erio

d pr

ior t

o be

ing

form

ally

with

draw

n, re

cord

with

draw

al d

ate

as fi

rst d

ate

of

abse

nce.

If C

hild

is s

till e

nrol

led,

che

ck N

A - a

nd s

kip

to It

em 2

1 an

d le

ave

Item

20a

bla

nk.

Ex: I

f Ch

ild h

as b

een

abse

nt s

ince

Apr

il 4

and

then

for

mal

ly w

ithd

rew

from

Mor

e at

Fou

r pr

ogra

m o

n A

pril

11, e

nter

wit

hdra

wal d

ate

as 4

/4/2

002.

20a.

If

Chi

ld w

ithdr

ew fr

om M

ore

at F

our,

indi

cate

reas

on �

Che

ck o

ne b

ox to

indi

cate

reas

on C

hild

w

ithdr

ew fr

om M

ore

at F

our.

If O

ther

, spe

cify

reas

on.

21.

Num

ber o

f day

s C

hild

atte

nded

Mor

e at

Fou

r cla

ssro

om e

ach

mon

th �

Ente

r the

num

ber o

f day

s th

at

Chi

ld w

as p

rese

nt in

the

clas

sroo

m fo

r eac

h m

onth

of M

ore

at F

our o

pera

tion

in th

is c

lass

room

. Fo

r mon

ths

for w

hich

the

Mor

e at

Fou

r pro

gram

did

NO

T op

erat

e or

for w

hich

the

child

was

not

enr

olle

d in

this

cl

assr

oom

, ent

er �0

� (ze

ro).

Ex: T

his

is a

n at

tend

ance

rec

ord

in a

cla

ssro

om t

hat

was

not

ope

rati

ng a

s a

Mor

e at

Fou

r cl

assr

oom

in J

anua

ry

and

bega

n en

rolli

ng c

hild

ren

Febr

uary

4, 2

002.

Thi

s Ch

ild e

nrol

led

on M

arch

7 a

nd w

as p

rese

nt o

n 12

day

s in

M

arch

, 3 d

ays

in A

pril,

and

non

e of

the

day

s in

May

(bec

ause

the

Chi

ld w

ithd

rew

fro

m t

he M

ore

at F

our

clas

sroo

m o

n A

pril

4).

22.

Has

this

Chi

ld b

een

refe

rred

for e

valu

atio

n fo

r a d

isab

ility

? � C

heck

one

box

to in

dica

te if

this

Chi

ld h

as

been

refe

rred

for e

valu

atio

n fo

r a d

isab

ility.

If Y

es, e

nter

dat

e of

refe

rral

(for

mat

ted

as m

m/d

d/yy

yy).

If N

o, s

kip

to

the

end

of th

e fo

rm a

nd le

ave

Item

s 22

a �

22e

blan

k.

22a.

Wha

t was

the

deci

sion

from

the

disa

bilit

y ev

alua

tion

for t

his

Chi

ld?

� Che

ck o

ne b

ox to

indi

cate

the

deci

sion

sta

tus

of th

is C

hild

�s d

isab

ility

eval

uatio

n. I

f No

disa

bilit

y w

as id

entif

ied

or if

the

eval

uatio

n de

cisi

on

is s

till i

n pr

oces

s, s

kip

to th

e en

d of

the

form

.

22b.

Typ

e of

iden

tifie

d di

sabi

lity(

ies)

for t

his

Chi

ld �

Che

ck a

ll th

at a

pply

to in

dica

te ty

pe o

f dis

abilit

y(ie

s) th

is

Chi

ld h

as b

een

iden

tifie

d w

ith.