Forms For Providers

Downloading Forms:

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The Provider Support Committee of the Early Learning Coalition of Pinellas, Inc (ELCP) and Coordinated Child Care of Pinellas, Inc. (CCC) are pleased to assist with the staffing needs in the early education and care field by listing job openings available for Pinellas child care providers that participate in CCC's quality assessment process. If you would like to have your job opening posted please fill out the form below.

Finance Forms:

Form Name Download (PDF)
Abuse Background Check Moved to Provider Services section below
Address Change Notification Link
Agreement for Electronic Funds Direct Deposit Link

Enrollment/Attendance Certification Instructions & Roster Sample

 Link
Holiday Schedule Link
Provider Affidavit Moved to Provider Services section below
Provider Early Payment Process Agreement Link
Provider Early Payment Process Change Notification Link
Provider/Client Rate Differential Worksheet Link
Relative/Non-Relative Affidavit Link
Request for Justification of Excessive Absences Link
Reimbursement Instructions & Sample Report Link
School Readiness Enrollment Link
Sign in/out Sheet (Sample) Link
Survey of Services and Proposed Rates and Fees Link
W-9 (IRS) Link

VPK Finance Forms:

Form Name Download
Agreement for Electronic Funds Transfer Link
Informed Parental Consent for Delayed Enrollment Link
Informed Parental Consent for Provider Transfers and Class Transfers Link
VPK Payment Request Form Link
W-9 (IRS) Link

For other VPK Provider Forms please see the VPK Section

Food Program Forms:

Form Name Download
2009-2010 Meal Count Worksheet with Provider ID Link
2010 Pre-Printed Regular Menu June Link
2010 Pre-Printed Regular Menu July Link
2010 Pre-Printed Regular Menu August Link
2010 Pre-Printed Regular Menu September Link
Approved Formula List Link
Building for the Future Form Link
Building for the Future Form Spanish Link
Child Participation Form Link
Infant Feeding Form Link
Medical Statement Form Link
WIC Flyer Form Link
WIC Flyer Form Spanish Link

Providers Services Forms:

Form Name Online Download
Abuse Background Check (Relative)   Link
Address Change Notification   Link
Child Accident (Unusual Incident) Report Follow Up - Homes   Link
Child Accident (Unusual Incident) Report Follow Up - Centers   Link
Confidential Log of Absences for Protective Services Children   Link
Parent Provider Conference Log   Link
Provider Affidavit (Relative)   Link
Sample Sign In Sheet   Link
Smoke Detector Testing Schedule   Link
Provider Online Training Schedule Link  

Provider Scholarship Forms:

Form Name Download
A.S. Degree Scholarship Program Information Link
A.S. Degree Application Form Link
N.E.S.T.S. Program Scholarship Information Link
N.E.S.T.S. Referral Form Link
N.E.S.T.S. Employer Agreement Form Link
N.E.S.T.S. Employee Agreement Form Link

Resource & Referral Forms:

Form Name Online
Provider Enrollment Update Link
Provider Rates Update Link
Provider Schedule Update Link

 

            

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