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FCCERS-R Assessment Request Form
FCCERS-R Assessment Request
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Directions: Please complete this form to request that a valid and reliable observation tool that will measure overall quality of the program, be conducted. 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.
What environmental rating scale do you need?
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Family Child Care Rating Scale (FCCERS-R)
Cost for FCCERS-R $500.00
Please enter the number of children that will be present during observation? Cannot be less than 2 present to conduct the assessment.
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How will you use the FCCERS-R results in your program?
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Please give three (3) dates you would like to hold for the observation.
Name
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First
Last
Email
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Phone
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Address
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Street Address
Address Line 2
City
ZIP Code
Hours of Operation Start Time
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MM
AM
PM
Hours of Operation End Time
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HH
MM
AM
PM
I agree to terms and service
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I acknowledge payment will be paid directly to the United Way of Connecticut. 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.
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