ECECD Instructional Materials Grant

Applicant Contact Information

Name of Childcare Center or Licensed/Registered Home*

Authorized Representative's Name*

First Name

Last Name

Authorized Representative's Email*

Contact Phone*

County *

Mailing Address of Center or Licensed Home*

Address Line 1

Address Line 2

City

State

ZIP Code

Funding Requests

You may request up to $3,000 to enhance services through the purchase of curriculum or learning materials for indoor and/or outdoor learning spaces. Limit 1 application per center location.

Examples of Approved Purchases:

books, puzzles, games, water or sand tables, blocks, sensory items, art supplies, easels, classroom tables, chairs, dramatic play materials, science materials, math manipulatives, and outdoor learning materials.

Please enter the dollar amount you are requesting up to $3,000* $

Please list what you will be purchasing.*

Please briefly describe how these materials will benefit your childcare program.*

Supporting Information & Documents

Please provide your Childcare Center's EPICS Provider ID *Required for Community-Based Programs Only

Please Upload Your Childcare Center's Completed & Signed W-9 Here. *Need a W-9 form? Go to www.crecnm.org & click “visit our news page"*

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File uploads may not work on some mobile devices.

E-Signature

By signing below, I certify the information I provided on this form and with this form is true and correct to the best of my knowledge.

Authorized Representative's Signature*

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Use your mouse or finger to draw your signature above

Date*

Grant Description

Before you start...

Applicant Contact Information

Funding Requests

Supporting Information & Documents

E-Signature