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OREGON’S QUALITY RATING & IMPROVEMENT SYSTEM MULTI-SITE PROGRAM REGISTRATION FORM This form is to be completed by programs who would like to use the multi-site portfolio process. One Registration Form is needed for each group of multi-site programs. How it works: Multi-site programs identify one program that they choose to be the main site. The main site submits a full portfolio that includes evidence for all standards. The individual sites will receive a simpler, shorter portfolio to complete. The scores from the common evidence that is sent with the main portfolio will be used when reviewing the individual site portfolios. Qualifications: To qualify to use the multi-site process, programs must meet the following requirements in addition to the Commitment to Quality requirements: • • •
There are 2 or more separate sites and license numbers. One mailing address and contact person will be designated for all sites. The programs use all of the common evidence in the common evidence checklist.
Common Evidence Checklist
Check if applies
Programs must use all of the common items listed to qualify.
Learning and Development LD1 LD2 LD9 LD10 LD11 LD12
Common philosophy Common curriculum(s) Common policy on screening and referral (if applicable) Common policy on group size, child-staff ratios, etc. Common policy on adult child interactions Common policy on behavior management
Health and Safety
HS1 HS3
Common policy for managing health and hygiene practices Common policy on healthy eating habits
PQ5 Common policy about ethics training Family Partnerships
FP1 Common policy about using family input FP2 Common policy on communicating with and including families Administration and Business Practices
AB1 AB2 AB3 AB4 AB5
Common business practices, policies & procedures Common policies on professional working climate Common policies about personnel evaluation Common practices promoting positive working relationships and professionalism Common comprehensive program evaluation
AB6
Common benefits are offered to encourage retention
HS5 Common policy on collaboration with health and related service professionals HS6 Common policy on screen time Personnel Qualifications
Yes, our programs meet all of the above requirements. _________________________ Signature
I:\train\QRIS\Multi-site\Final Documents\Multi-site application 12-1-15 final.docx
MULTI-SITE PROGRAM REGISTRATION FORM, PAGE 2 Complete the information below and include this form with all of the applications for Commitment to Quality for each licensed site. Please send them together. Contact person for all sites:
Title:
Email Address: (of contact) Main Mailing Address:
Phone: (
) ___________________
________________________________________________________________
Name of main site:
Street Address City
State
License # of main site:
1. Name of individual site :
License # of individual site:
2. Name of individual site :
License # of individual site:
3. Name of individual site :
License # of individual site:
4. Name of individual site :
License # of individual site:
5. Name of individual site :
License # of individual site:
6. Name of individual site :
License # of individual site:
7. Name of individual site :
License # of individual site:
8. Name of individual site :
License # of individual site:
9. Name of individual site :
License # of individual site:
10. Name of individual site :
License # of individual site:
11. Name of individual site :
License # of individual site:
12. Name of individual site :
License # of individual site:
13. Name of individual site :
License # of individual site:
14. Name of individual site :
License # of individual site:
15. Name of individual site :
License # of individual site:
16. Name of individual site :
License # of individual site:
17. Name of individual site :
License # of individual site:
18. Name of individual site :
License # of individual site:
19. Name of individual site :
License # of individual site:
20. Name of individual site :
License # of individual site:
Attach additional sheets if necessary. I:\train\QRIS\Multi-site\Final Documents\Multi-site application 12-1-15 final.docx
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