Attachment C - Recorded Program Eligibility Questionnaire.pdf

Department of Early Learning and Care (DELC) Recorded Program Eligibility Questionnaire

To determine if your program meets the requirements for becoming a School-Age Recorded Program through the DELC’s Child Care Licensing Division, please fill out the form below.

Is your program:

1. Mostly a group athletic or group social activity sponsored by an organization club or hobby group such as the Girl Scouts?

Yes No

2. Focusing on a single enrichment activity for school-age children and operating for no more than 8 hours a week, such as swimming lessons or tutoring?

Yes No

3. Operated by a school district, charter school, political subdivision of the state, or a government agency?

Yes No

4. Are all participants in your program 14 years of age and older? Yes No

5. Providing care to children while their parent remains on site and engaged in an activity?

Yes No

If you answered yes to any of the questions above, your program does not need to be recorded with DELC. Please complete the attestation below by signing, dating, and returning this document to the Oregon Department of Education.

I attest that the above information is correct and true to the best of my knowledge.

Signature Date

If you are not able to answer yes to any of the questions above or you are not sure how to answer the questions, please complete the information below and email it to: CCLD.CustomerService@delc.oregon.gov

Program Name:

Name of Program Contact Person:

Phone Number:

Email Address:

What County is the program in:

What ages of children does your program support:

Hours of Operation:

Do you operate as part of a parent co-op*? Yes No

*Note: A parent cooperative (co-op) operates for no more than 4 hours a day and: (a) Care is provided on a rotating basis by parents that are members of the cooperative. and (b) Is overseen by a board of directors responsible for developing written program policies and procedures that are shared with all the members.

Brief Description of your program:

Once this form is received by the Child Care Licensing Division, it will be sent to a Licensing Specialist who will contact you to either provide you with information on the process of becoming a Recorded Program or they will send you an email stating your program is not required to register as a recorded program. That email will serve as verification to supply to the Oregon Department of Education. UnL-0576 | 1/2024