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Application for Day Home Educator

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Address *

Besides yourself who else will be in your home during operating hours? *

Why do you want to become a day home educator? *

Do you have education in this field? *

Level 1 Level 2 Level 3 CYC No but willing to get my FREE level 1 course No unwilling to continue education Other equivalent to level 2 Other equivalent to level 3

What equivalent do you have? *

Describe how you would set up your play area *

Do you have pets? *

Yes No We're a literal zoo

Explain your pets *

A child of 2 scribbles on the wall, how would you handle this? *

A 3-year-old won't eat lunch, how should you handle this? *

Do you have your own children? *

Yes No Yes and grown up Someday

How old and how many children do you have? *

Do you have a day home now? *

Yes licensed Yes private No I have had one in the past

If you have a private day home, why are you wanting to go with an agency? *

Name your last two employers, your roll and why you left? *

Can we talk with them? *

Yes No

Explain your experience working with children (yes parenting counts)? *

Explain your approach to child guidance *

Do you or anyone in your home have a criminal record? *

Yes - Me Yes - Other No

If you answered yes to the above please explain *

Have you or anyone in your home been involved with any child welfare matter? *

Yes - Me Yes - Other No

A 15-month-old bites another child, what would you do? *

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