ECERS-3 Assessment Request Form

Directions: Please complete this form to request that a valid and reliable observation tool that will measure overall quality of the program, be conducted. One form per program. The cost of this observation is $500, which includes a minimum of three hours of observation and a written report, completed within 3 business days of the visit. Please complete this form in its entirety.

Type of Care*

Child Care Center

Group Child Care Home

What environmental rating scale do you need?*

Early Childhood Environment Rating Scale Third Edition (ECERS3)
Cost for ECERS3 $500.00 per classroom

What is the number of preschool classrooms to receive ECERS3?*

Please enter the number of children that will be present during observation? Cannot be less than 2 present to conduct the assessment.*

How will you use the ECERS-3 results in your program?*

Please give three (3) dates you would like to hold for the observation.

ECERS-3 Assessment Request Form

ECERS-3 Assessment Request

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