Administrator Information Packet
Accreditation Visit
Purpose
The Administrator Information Packet provides program administrators with additional information
regarding the various forms and procedures that are commonly used during NAEYC visits, as
well as helpful information about what to expect after the visit is completed.
NAEYC Assessors will reference and use the following forms throughout the visit as needed.
Program administrators are encouraged to carefully review and familiarize themselves with these
forms before the visit.
For more information regarding the forms and procedures used by NAEYC Assessors during site
visits, refer to the appropriate visit protocol within the NAEYC Academy website.
Table of Contents
1. Process Verification Form Cover Page
2. Process Verification Form
3. Required Criterion and Scope and Severity Cover Page
4. Required Criterion Report Form
5. Required Criterion Diagram Form
6. Scope and Severity Response Form
7. Missing Evidence Request Form Cover Page
8. Missing Evidence Request Form
9. Evidence Check Form Cover Page
10. Evidence Check Form
11. Outdoor Learning Environment Form
12. Safety Concerns Report Form
13. Visit Signature Form
14. First Aid/CPR Acknowledgment Form
15. Infant Sleep Equipment Acknowledgment Form Cover Page
16. Infant Sleep Equipment Acknowledgment Form
17. License Exempt Acknowledgment Form
18. Next Steps
Administrator Information Packet
Effective October 1, 2015
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© 2014. National Association for the Education of Young Children. All rights reserved.
Process Verification Form Cover Page
Information for the Program Administrator:
The Process Verification Form (PVF) is critical to ensuring the reliability and validity of the visit
assessment. It is designed to serve as a guide for both Program Administrators and Assessors,
detailing the tasks that must occur as part of the visit assessment. This is the mechanism for
administrators to confirm that the NAEYC visit protocol was followed.
A blank sample copy of the PVF is included in this information packet. The assessor will complete
the form as each task is completed during the Orientation Meeting and the Closing Meeting. The
Assessor and Program Administrator will affirm that all tasks have been completed as outlined in the
Process Verification Form by signing the Signature Form during the Closing Meeting. The completed
Process Verification Form and Signature Form will be e-mailed to the Program Administrator
following the visit.
Administrators are encouraged to review the Process Verification Form before the visit. You may
also wish to follow along during the Orientation Meeting and Closing Meeting as each task is
completed and checked off by the assessor.
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Process Verification Form
This form includes Orientation Meeting and Closing Meeting process verification checklists for three types of
visits: Accreditation Visit/Accreditation Visit with a School-Age Component, Verification Visit, and Initial
School-Age Visit. Checking each box indicates that the item was reviewed; it does not indicate that the
program administrator agrees with the item.
Orientation Meeting Process Checklist
All Visits: Complete the following tasks for all types of program visits, including Announced Verification Visits.
Lead Assessor: introduce and identify all NAEYC staff present; show ID
Verify number of observations and age categories follow protocol.
Verify that observation times occur when groups are in session and not napping.
Schedule
Ask if there are children with identified special needs enrolled in each group selected for
observation.
Determine teaching staff to be observed and add to schedule; request first aid & CPR
documentation for those staff.
Missing Evidence Request Form
(MERF)
Review:
Infant Sleep Equipment Acknowledgement
Form ( N/A)
Required Criterion Report Form
Safety Concerns Report
Required Criterion Diagram Form
Outdoor Learning Environment Form
Scope and Severity Response Form
Signature Form
Request permission to access classroom books, materials, closets, drawers and cupboards
Does program use tamper resistant outlets?
Yes
No
Some rooms /halls:
Show data collection tools: choke tube, measuring tape, tablet computer
Facility Orientation to program space and staff, including classrooms, grounds, Assessor workspace, and
storage location of staff files.
Complete Outdoor Learning Environment Form.
Orientation Meeting – Accreditation Visit: Complete the following additional tasks for
Accreditation Visits. This also includes Accreditation Visits with a School-Age Component.
Staff
Changes
Review
N/A
No staff changes have occurred since the last communication with the NAEYC Academy.
New staff are present at the program. Assessor directs program administrator to the Fax Cover
Sheet for Staff Changes included as a link in the AIP.
Evidence Check Form
NAEYC Self-Assessment FS and TSS are present and have been tallied on summary forms.
Surveys
Paper copies of summary forms (both TSS and FS) will be collected during the visit.
Digital scans of summary forms (both TSS and FS) will be collected during the visit.
Digital copies of summary forms (both TSS and FS) were received prior to visit.
Portfolios
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Ask about E-Portfolios: if applicable request a quick orientation to the computer
N/A: Program has not prepared any E-Portfolios
Check
one of
these.
Orientation Meeting – Initial School-Age Visit: Complete the following additional tasks for
School-Age Visits.
Licensing
N/A
Request documentation of program’s current license/regulatory status.
Orientation Meeting – Unannounced Verification Visit: Complete the following additional tasks
for Unannounced Verification Visits.
Intro Letter
Responsible Person is given introductory letter and accepts the verification visit.
AIP
Responsible Person is directed to the Administrator Information Packet on the NAEYC
website.
N/A
Ask responsible person for the current number of groups and each group’s identified age
category or categories. Refer to Age Category Chart on Classroom Selection Form if
responsible person asks for clarification.
Classroom
Selection
Form
Conduct random selection of groups to be observed.
Confirm that selected observations include the appropriate amount of groups (to a maximum
of eight observations) and at least one group from each age category in the program.
Execute signature at bottom of Classroom Selection Form.
Closing Meeting Process Checklist
All Visits: Complete the following for all types of program visits.
Site Visit Schedule
Final, annotated copy; Show the actual time all tasks were performed.
Missing Evidence Request Form (MERF)
Check all that apply as follow-up for possibly failed required criteria:
Review
Required
Criterion
Report
Form
None
Include Administrator Response
Timeline for program response
Inform admin the Scope and Severity Response Form(s) will be in VCP
Inform admin the First Aid/CPR Acknowledgment Form will be in VCP.
Inform admin the Infant Sleep Equipment Acknowledgement Form will be in VCP.
Reviewed Required Criterion Diagram Form.
Safety Concerns Report
Outdoor Learning Environment Form
Evidence Check Form (
N/A)
Next Steps flyer
Included in the AIP and available on the NAEYC website.
Administrator Evaluation:
Review purpose of evaluation
Link can be found on the Next Steps Flyer; link is also included in the
Visit Completion Packet (VCP) provided after the visit.
Make photocopies of the Visit Schedule, MERF, and (if applicable) RCDF(s).
Confirm program email address(es). Remind program that if they have not received the Visit
Completion Packet (VCP) within two business days, to contact the assessor immediately.
Direct program administrator to contact the Academy with any questions or concerns after the visit.
Explain that you will note the ending time of the Closing Meeting on the schedule at the close of the
meeting.
Signature Form
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Check all boxes and sign this form (both the program administrator and assessor/s)
at the end of the Closing Meeting.
Required Criteria Report Form and
Scope and Severity Response Form Cover Page
Information for the Program Administrator:
The Required Criterion Report Form (RCRF) is used by the assessor to document program
compliance with NAEYC’s Required Criteria. The Scope and Severity Response Form (SSRF) is
used by the program in order to respond to the NAEYC Academy only if there is a possibly failed
observable Required Criterion.
The NAEYC Required Criteria listed on the next page must be met by programs in order to earn
NAEYC Accreditation. On a visit, the assessor will use reasonable judgment to determine if all
required criteria are met, or if one or more are possibly failed. These ratings may be subject to
change, pending further review at the NAEYC Academy.
If the assessor determines that all required criteria are met, the assessor will check the applicable
box on the Required Criterion Report Form (RCRF). In this case, the program does not need to
respond to possible failures of a required criterion and the Scope and Severity Response Form
(SSRF) will not be used. Should there be a possible failure of a required criterion, the assessor will
complete the Required Criterion Report Form accordingly and review it, and if the possible failure is
of an observable required criterion, the Scope and Severity Response Form will also be reviewed
with the Program Administrator at the Closing Meeting. During the Closing Meeting both assessor
and program administrator will affirm that the review procedures have been followed on the visit by
reviewing and signing the Signature Form.
The NAEYC Academy is obligated to report to the designated program representative present at
the Closing Meeting any NAEYC Required Criteria that may not be fully met. This process is
established so that the program representative can respond to the information provided to the
NAEYC Academy as well as determine if any additional action is necessary in conjunction with
their state laws and regulations and program operation. If an assessor witnesses that any child is in
immediate risk for harm or abuse, the assessor will notify the program staff immediately and may
be required to directly contact the appropriate authorities as well as the NAEYC Academy.
If the assessor determines that there is a possibly failed Required Criterion, the assessor will:
1. Continue with the assessment and complete the visit unless a child is in immediate risk for
harm or abuse;
2. Check each required criterion on a Required Criterion Report Form that has a possible failure;
3. Fully document the finding(s) on copies of the Required Criterion Report Form; and
4. Review the Required Criterion Report Form(s) at the Closing Meeting.
If the assessor determines that there is a possibly failed Required Criterion, the program
administrator will have the opportunity to:
1. Respond in writing directly on the Required Criterion Report Form;
2. Choose not to respond during the visit, by checking the appropriate box on the Required Criterion
Report Form; and/or,
3. Provide additional contextual documentation and policies within five business days of receipt
of the Required Criterion Report Form and Scope and Severity Response From(s)(for
observable possible failures) for any potential failures of required criteria.
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To submit additional documentation, please either surface mail or email to
[email protected]; do not both surface mail and email additional documentation. Be sure
to include your Program Name and ID number in the subject line. We will confirm receipt via email.
Ensure that all confidential program information is fully redacted from any materials sent as part of
your response.
Please note: Programs have 30 days to submit additional documentation for 5.A.03, and 60 days
for 5.A.12a with regard infant sleep equipment compliance. In some instances, the NAEYC
Academy may also contact the program directly for any further information or documentation after
the visit documents have been received and processed.
Possibly failed observable required criteria that the assessor identifies during the visit will be
evaluated using the “Scope and Severity Screen”. The Scope and Severity Screen is applied by the
Scope and Severity Committee, which consists of experts in the early education field with
experience and knowledge of NAEYC Accreditation of Programs for Young Children. The
Committee’s decisions are tracked and monitored for consistency, and the Committee is governed,
along with the work of the entire NAEYC Academy, by the NAEYC Council for Accreditation. For
more information about the Scope and Severity Screen, please refer to the NAEYC Required
Criteria Policy at
www.naeyc.org/files/academy/file/RequiredCriteriaPolicy.pdf
Required Criteria (condensed):
1.B.09 (I-T-P-K) Teaching staff never use physical punishment, such as shaking or hitting and
do not engage in psychological abuse or coercion. [GOE, PP]
3.C.02 (I-T) Teaching staff supervise infants and toddlers/twos by sight and sound at all times.
[GOE, PP]
3.C.04 (P-K) Teaching staff supervise children primarily by sight; supervision for short
intervals by sound is permissible, as long as teachers check frequently on children who are
out of sight. [GOE, PP]
5.A.03 (I-T-P-K) Presence of at least one staff member successfully trained in first- aid, and CPR
(with Infant/Child or Pediatric component). [GOE, PP, TS]
5.A.12 a. (I) Infants placed on their backs to sleep on a firm surface that meets the standards of
the United States Consumer Product Safety Commission, unless otherwise ordered by a
physician. [GOE, PP]
10.B.04 (I-T-P-K) The program and facility are licensed to operate or are regulated by the
applicable state and local regulatory systems. The program maintains documentation showing
that it is considered in good standing by its regulatory bodies, and it can document all
certifications, approvals, and corrections of violations and deficiencies. [PP]
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Required Criterion Report Form
Assessor: Section 1 must always be completed. Complete Section 2 (optional; below) if any possible failures were
caused by Program Portfolio evidence. Section 3 should be completed with the program administrator during the
Closing Meeting if there are any possible failures due to either source of evidence. If applicable, complete one copy of
Section 4 (page 2) to describe each possible failure due to Observable evidence. If you complete Section 4, you will
need to send the Scope and Severity Response Form (SSRF) to the Program Administrator, with the Visit Completion
Packet email following the visit. The program administrator will need to compete and submit one SSRF for each
possible failure of observed required criteria.
Administrator: On the day of the visit you may respond to any possible failures of required criteria in Section 3 (below). If
there were any possible failures due to Observable evidence, complete a Scope and Severity Response Form (SSRF) for
each possible failure after the visit has been completed. The assessor will send the SSRF within an email, within two
business days after the visit. The assessor will review the SSRF with you, the administrator, during the Closing Meeting for
any possible failures due to Observable evidence.
All Required Criteria Met. No further action is needed on this form.
Section 1
Check Criteria
Possibly Failed:
1.B.09
3.C.02
3.C.04
Possible Failures(s) of Required Criteria. Check all criteria possibly failed below. Indicate which
Source(s) of Evidence caused the possible failure. Count the number of possible failures for each
required criterion, and then enter the total for all criteria. Each possible failure within and across
Sources of Evidence counts as a separate instance.
Source of Evidence
PP:
Obs.
# of
possible
failures:
Actions
For possible failures due to Observable evidence: Program Administrator was
directed to the Scope and Severity Response Form (SSRF) at this time (Closing
Meeting).
If helpful, attach a clearly labeled diagram of an observed incident. (See Required
Criterion Diagram Form). Indicate in Section 4 that you are including a diagram.
For possible failures due to Observable evidence: Program Administrator
was directed to the Scope and Severity Response Form (SSRF) at this time (Closing
Meeting).
5.A.03
Assessor: Complete Section 2 if this criterion has possibly failed.
Program Administrator was directed to First/Aid CPR Acknowledgment Form in
the Information Packet at this time (Closing Meeting)
5.A.12a
Assessor requested doctor’s note on MERF for an observed incident, but it was
not provided.
For possible failures due to Observable evidence: Program Administrator was
directed to the Scope and Severity Response Form (SSRF) at this time (Closing
Meeting).
Program Administrator was directed to Infant Sleep Equipment Acknowledgement
Form in the Information Packet and has chosen not to execute it at this time.
10.B.04
Program lacks a full, current license.
Program lacks a full, current license and volunteered information about a related
critical event. Assessor directed Program Administrator to submit a 72-Hour
Notification Form or Appendix 2 and 3.
Program Administrator was directed to the License-Exempt Acknowledgment
Form in the Information Packet and has chosen not to execute it.
Total number of
possible failures:
Section 2. Assessor’s description of Program Portfolio evidence related to possible failure of a required
criterion.
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Section 3. Administrator’s response to the possible failure of any Required Criterion (both Observable and
Program Portfolio evidence) :
I, the Administrator, choose not to provide a response at this time. [Or write response here.]
Section 4. Assessor’s description of Observable evidence for a possibly failed required criterion
Assessor, provide the following details for one possible failure of a Required Criterion based upon observable evidence.
Complete multiple copies of Sections 4 if more than one observable failure is being documented. Use the optional
Required Criterion Diagram Form (a paper document) if you wish to include a drawing as evidence.
Copy ___ of ___. Criterion #:
Source of Evidence:
GOE
Date of Incident:
diagram included.
None (observed outside of a classroom observation period)
Assessor Completing this Page (Name, ID#):
Group Name:
Age(s) of Child(ren):
Adults Present:
Time/Duration of Incident:
Setting (outdoor learning environment, classroom, hallway, etc.):
Specific Description of Incident:
If Section 4 is completed, a Scope and Severity Response Form (SSRF) must be submitted to the NAEYC Academy by
the program to provide additional contextual documentation for any possible failure of a required criterion based upon
observed evidence (Criteria 1.B.09, 3.C.02, 3.C.04, or 5.A.12a “back to sleep”). The information submitted will be used to
determine if there are grounds for conducting a review of the incident using the Scope and Severity Screen in accordance
with the Required Criteria Policy. The SSRF will be sent to the program administrator, for failure of a required criterion
based upon observed evidence, within the Visit Completion Packet email within two business days following the visit.
Program Administrator: You may submit additional contextual documentation (including program policies) for any
potential failures of required criteria within five business days (30 days for 5.A.03; 60 days for 5.A.12a for infant sleep
equipment) of program’s receipt of the Visit Completion Packet. The Visit Completion Packet is transmitted by the NAEYC
Assessor within two business days after the completion of the visit. Ensure that confidential program information is fully
redacted from any documentation sent as part of your response.
Submission Instructions. NAEYC prefers to receive this documentation through email, but surface mail submissions are
acceptable; please only send documentation via one of these options. Be sure to include your Program Name and ID
number in the subject line of emails. NAEYC will acknowledge receipt of your forms, so please re-contact us if you do not
receive an acknowledgment after submission.
Email: [email protected]
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Mail:
NAEYC Academy Quality Assurance
1313 L Street, Suite 500 NW
Washington, DC 20005
Required Criterion Diagram Form
Program Name:
Required Criterion Cited:
Program ID:
Date of Incident:
Group Name:
Completed by:
This form can be completed by an NAEYC Assessor or by a member of program staff when a possibly failed
Required Criterion has been reported on an accreditation site visit. It may be helpful to include a diagram of the
space (e.g., classroom, outdoor learning environment or playground, corridor) where the possible failure
occurred. Use the area below. Be sure to include relevant details such as the location of teaching staff,
children and/or others; location of walls, furniture and/or door; and height of walls and furnishings. Add labels
and text as needed.
(45 rows x 42 columns)
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Scope and Severity Response Form
This form is used to provide the NAEYC Academy with additional contextual
documentation for any possible failure of a required criterion based upon observed
evidence (Criteria 1.B.09, 3.C.02, 3.C.04, or 5.A.12a).The information submitted will be
used to determine if there are grounds for conducting a review of the incident using the
Scope and Severity Screen in accordance with the Required Criteria Policy
Directions for Program Administrator: Use this page to provide details for one
possible failure of a Required Criterion based upon observable evidence. If more
than one possible failure of a required criterion was documented by the
Assessor, complete an additional copy of this form for each instance. By
submitting this page complete and on time, a program is complying with
requirements necessary for maintaining or pursuing NAEYC Accreditation.
NAEYC Program ID#:
Program Name:
Name:
Title:
Phone:
Email:
Have you submitted any other notifications of critical events to NAEYC within the last
twelve (12) months?
No
Yes
Program’s Account of the possible failure of an observed Required Criterion.
See Section 4 (page 2) of the Required Criterion Report Form for the Assessor’s
description including date the incident occurred, duration and time of the incident(s),
group information, and age of the child(ren) involved.
Ensure that confidential program information is fully redacted from any materials
submitted as part of your response.
Required Criterion: Indicate which criterion you are reporting on this form.
1.B.09
1
3.C.04
5.A.12a
Optional: Consider your assessor’s description of the possible failure of the
observable Required Criterion. If you would like to add anything to the description,
attach a written description and/or a copy of any diagrams or pictures of the
location, if relevant. Remove all personal identifying information, including names
of program staff members and children, before submission. Include the Program
ID on any attachments.
Attached:
2
3.C.02
Written Description
Diagram(s)
Pictures
Required: Attach your response, including an analysis of the root causes of the
incident and subsequent actions (such as personnel actions). Include the
Program ID on the attachment.
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Did you have relevant written policies/procedures in place prior to the incident(s)?
Yes – Attach a copy of the relevant written policies/procedures (with
Program ID) in place prior to the incident(s).
3
No
Have you implemented new policies/procedures or ongoing improvement plans for
follow-up and prevention?
Yes – Attach a copy of the relevant written policies/procedures (with
Program ID) in place prior to the incident(s).
4
No
Attach documentation of the status or results, regardless of the outcome, of any
investigations by ALL licensing, regulatory, medical examiner, police or other
authorities regarding the incident. Include the Program ID on all attachments.
Please include:
Corrective Action Plan detailing actions or steps that have or will be taken
to correct the incident
Not available at this time
5
Any administrative action ranging from a written reprimand, to the issuance of
a provisional license, to a summary suspension if there is an immediate and
present danger to children
Not available at this time
A copy of your program’s last licensing report (please note that the
NAEYC Academy may also contact the licensing regulatory body to
request this report if it’s not provided or for additional clarification on the
report).
Not available
at thisalltime
Submission Instructions.
Submit
pages of the Scope and Severity Response
Form, along with additional contextual documentation if needed, within five business
days of your program’s receipt of the Visit Completion Packet. The Visit Completion
Packet is sent by the NAEYC Assessor within two business days after the
completion of the visit. NAEYC prefers to receive this documentation through email,
but surface mail submissions are acceptable; please only send documentation via
one of these options. NAEYC will acknowledge receipt of your forms, so please recontact us if you do not receive an acknowledgment after submission.
Email: [email protected]
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Mail: NAEYC Academy Quality Assurance
1313 L Street, Suite 500 NW
Washington, DC 20005
Missing Evidence Request Form (MERF): Accreditation Visit
Information for the Program Administrator
At the time of the accreditation visit, your program should have compiled and organized written evidence
needed to demonstrate compliance with NAEYC Program Standards. However, if the assessor is unable to
locate evidence needed to rate a criterion from specific sources of evidence, the criterion for which
evidence is missing will be listed on the Missing Evidence Request Form (MERF). You will be given the
opportunity to locate and label this evidence for the assessor to review. The MERF will be provided to you
approximately two hours before the end of the accreditation visit. You will have no less than one hour to
return all evidence to the assessor.
This is not an opportunity to create new documentation demonstrating your program’s compliance with
NAEYC program standards. Rather, this is an opportunity to locate existing documentation that the
assessor may not have found. Furthermore, the assessor will only request missing evidence. The missing
evidence may refer to an entire missing standard, all of a criterion, or some indicators of a criterion. If
documentation is present that does not meet the requirements of a criterion, no further information will be
requested.
Although the assessor is unable to discuss the missing evidence, you may photocopy this form and refer to
your Standards and Accreditation Criteria book or TORCH to assist you and/or your staff in returning the
missing evidence for each criterion listed on this form. You will also have access to all the evidence you
previously submitted to the assessor. Please clearly label and/or highlight evidence you submit. Verbal
evidence will not be considered.
The MERF will include a table that shows which missing evidence is from required criteria, and which is
from emerging criteria, as a means for programs to prioritize the missing evidence task. The assessor will
circle any required or emerging criteria in this table in addition to listing it in the table for the specific source
of evidence.
If no missing evidence is requested, the assessor will check the appropriate box to indicate this at the top
of the form.
Observable Criteria (Group Observable Evidence & Program Observable Evidence). Assessments of
observable evidence are made solely by assessors who meet rigorous reliability training. Missing evidence
IS NOT requested for these sources of evidence. If a child is laid in a position other than on his/her back
during an observation, the assessor will request on the MERF to see a doctor’s note allowing for that child
to be placed in an alternate position in reference to Required Criterion 5.A.12a.
Classroom Portfolio. Classroom portfolios provide evidence of how specific groups are meeting the
accreditation criteria. The portfolio demonstrates the group’s capacity to perform the criteria consistently
over time and can be used to supplement the results of a single group observation. Since the Classroom
Portfolio is designed to supplement the results of the group observation, missing evidence IS NOT
requested for this source of evidence.
Required & Emerging Practice Criteria. Required Criteria are so fundamental to program quality that they
MUST be fulfilled to achieve NAEYC Accreditation. Your program must meet each Required Criterion.
Emerging Practice Criteria are important to program quality but are not yet widely practiced by the early
childhood field. Your program does not have to meet Emerging Criteria. You will receive credit for meeting
Emerging Practice Criteria, but will not be penalized for failing to do so. If your program has decided not to
meet Emerging Criteria, the assessor will still list the Emerging Criteria on this form if evidence is missing
(i.e., if a criterion is not addressed in any way).
Missing Evidence Request Form Cover Page
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Page 1 of 1
Effective October 2015
Program ID: ____________
Missing Evidence Request Form (MERF): Accreditation Visit
Directions to Assessor: Note missing evidence by source of evidence (Program Portfolio (PP), Family Survey,
Teaching Staff Survey). For PP evidence, list the criterion and/or indicator then briefly describe the content of the
criterion or indicator. If one or more entire standards are missing from the PP, request “All Standard xx criteria
for which Program Portfolio evidence is required”.
Note on the schedule when the MERF was given to the administrator and when it was returned to the assessor.
No Missing Evidence Reported (Assessor: check here if you did not identify any missing evidence.)
Missing Evidence Reported. Form is due back to assessor by (time):
Assessor directed program to Infant Sleep Equipment Acknowledgement Form related to assessment of
5.A.12.a
Assessor directed program to License-Exempt Acknowledgement Form related to assessment of 10.B.04
The table below shows which missing evidence is from required criteria, and which is from emerging criteria, as a means
for programs to prioritize the missing evidence task. Assessor: Circle any criteria in this table that you have listed.
Required Criteria
1.B.09 3.C.02
5.A.03 5.A.12a
3.C.04
10.B.04
Emerging Practice Criteria
4.C.01 4.D.02 4.E.07
7.A.04 7.C.05 8.A.06
5.A.02
8.A.07
5.A.08h
9.B.07
5.A.10
10.B.03
5.B.10a 6.A.11
10.B.10 10.F.05
6.B.02
Missing Program Portfolio Evidence
If Required Criterion 5.A.03 is listed as missing based on Program Portfolio Evidence, list the groups and/or staff for
which evidence is missing or incomplete.
Criterion
Description of Evidence Not Found
Doctor’s Note Request generated from Observation
Request for a Doctor’s Note for the following children:
Missing Survey Evidence: This section should be used if the Evidence Check Form
request for missing survey data has not been addressed.
1.
2.
3.
4.
Surveys are not present.
Survey Summary Sheets are not present.
The Self-Study version was used.
The number of surveys presented does not appear to match the number of
surveys reported on Summary Sheet.
5. Pages and/or questions within the summary sheet are not complete.
6. Spot check: The number of responses to individual questions does not add up to
number of surveys returned.
Survey Notes:
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Family
Survey






Teaching
Staff Survey






Evidence Check Form Cover Page
Purpose: The Evidence Check Form serves as a way for assessors to detect common problems with
the NAEYC Teaching Staff and Family Survey evidence early in the visit, thereby allowing programs
an opportunity to locate missing evidence or correct incomplete evidence. Additional information
regarding survey evidence can be found on the following pages.
Implementation: During the Accreditation Visit Orientation Meeting, the assessor will review the
Evidence Check Form with the Program Administrator. The program must provide the NAEYC Family
and Teaching Staff Survey documentation at this time, so the Assessor can complete the Evidence
Check Form (ECF) immediately following the Orientation Meeting.
Survey Evidence: The assessor will review the NAEYC Family and Teaching Staff Survey evidence
that has been provided. He or she will check that the returned surveys are present, that the “SelfAssessment” versions were completed, and that the results have been tallied. There are two possible
outcomes of this process:
1. If all NAEYC survey evidence is present and appears to be in order, the assessor will indicate
this on the ECF and nothing more needs to be done. Visit tasks will continue as scheduled.
2. If any of the NAEYC survey evidence appears to be missing or incomplete, the program will be
informed of the specific issues that need to be addressed. The program will then have as much
time as allowable within the schedule to collect and/or locate the necessary documentation. All
requested NAEYC survey documentation must be presented to the Assessor at the time the
Missing Evidence Request Form (MERF) is due back, near the end of the visit.
Survey Evidence- Overview: Whether you are a first-time candidate for NAEYC Accreditation, or a
program renewing your accreditation after 5 years, during your accreditation visit you will be asked to
provide documentation of the NAEYC Family Surveys and Teaching Staff Surveys completed during
your Self-Assessment. These surveys must be conducted within 12 months of your program’s
Candidacy or Renewal due date.
There are two types of documents that the assessor will need to review for both the NAEYC Teaching
Staff and Family Surveys: (1) the actual copies of the NAEYC surveys you collected from families
and staff; and (2) a tally of each NAEYC survey’s results (referred to as the Summary Results).
The following guidelines may help to assure that you have collected and compiled the correct
information prior to your visit.
Survey Versions

Self-Study vs. Self-Assessment Versions: NAEYC provides two versions of the Family Survey
and two versions of the Teaching Staff Survey for programs to use at different stages of their
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quality improvement work in preparation for accreditation. The “Self-Study” versions are for the
program’s use only and are not requested by the assessor during the accreditation visit. The
“Self-Assessment” versions are the “evidence” evaluated for accreditation. They should be
collected, tallied and available for the assessor to review during the accreditation visit. Here is
how to confirm the correct version:
o The version type (self-study or self-assessment) can be seen on the top right corner of
both the Teaching Staff and Family Survey forms.
o Self-Assessment Family Surveys have 24 Questions and include response options
‘Yes’, ‘No’, ‘Don’t Know’, and ‘Not Applicable’.
o Self-Assessment Teaching Staff Surveys have 46 questions organized by NAEYC
Standards (“Relationships”, “Curriculum”, etc.) and include response options ‘Yes’, ‘No’,
‘Don’t Know’, and ‘Not Applicable’.
o What if my program has completed only “Self-Study” Family and/or Teaching Staff
Surveys?
o If you believe that you may have completed only “Self-Study” Family and/or Teaching
Staff Surveys, it is recommended that you attempt to have the “Self-Assessment”
Family and Teaching Staff surveys completed and the results tallied on a summary
sheet prior to your accreditation visit.
o If time does not allow for you to distribute, collect, and tally the “Self-Assessment”
surveys prior to the start of the 15-day window in which your visit will occur, the
assessor will collect the tallied results for the “Self-Study” Family and Teaching Staff
surveys. The “Self-Study” summary results can be used for scoring, but they may
affect your program’s performance outcome across the 10 Standards.
Survey completion dates
Verify that the NAEYC self-assessment surveys have been completed within 12 months of your
program’s Candidacy or Renewal date. Candidacy/Renewal submission dates are January 31, May
31 and September 30.
Summary Results

What Information to Report: On TORCH (NAEYC’s online community to assist with
accreditation) you will find Microsoft Excel spreadsheets you can use to tally the results from
your NAEYC Self-Assessment Family and Teaching Staff surveys. Use of these resources is
optional, but they do provide a clear framework for what information to report, and they
automatically calculate response rates for all questions.
If you use some other format to tally your survey results, verify that you have the following
information:
o Your program name, program ID#, and date surveys were distributed.
o Total number of surveys distributed and total number of surveys returned.
o Tallies of the total number of ‘Yes’, ‘No’, ‘Don’t Know’, and ‘Not Applicable’ responses to
each question for both Teaching Staff and Family Self-Assessment surveys. Do not
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
report only percentages – we need the actual numbers of each response for each
question. If your program has multiple sites, be sure that you have combined the results
from each site into one cohesive tally of results.
Response Rates: Ensure that you have appropriate response rates. Programs must receive at
least 80% of all Self-Assessment Teaching Staff Surveys distributed, and at least 50% of all
Self-Assessment Family Surveys distributed, for the results to be counted.
Collecting and Tallying Surveys Online
Programs may choose to distribute and collect the NAEYC Self-Assessment Family and Teaching
Staff Surveys via an online survey service such as Survey Monkey or Kwik Surveys. If you have
chosen to use an online survey service, assessors will still need to review the surveys returned and
obtain a copy of the tallied summary results. Some online services may allow you to download and
printout the necessary information; others may require that you provide the assessor access to the
results online so they can be verified against the tallied summary results. If you choose to utilize this
option, be sure that the numbering system you use to collect your responses corresponds to the
NAEYC numbers found in the posted surveys.
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Evidence Check Form
Purpose: The purpose of this form is to verify that the NAEYC Teaching Staff Surveys and Family Surveys have been
collected and compiled correctly. This form is to be completed immediately following the Orientation Meeting.
N/A: This is a Verification Visit. The NAEYC Family Surveys and Teaching Staff Surveys are not assessed during
these visits.
Step 1: Check Survey Evidence. Indicate whether the program has provided the necessary documents to verify and
collect the “Self-Assessment” versions of the NAEYC Family Survey and Teaching Staff Survey results. If any response is
‘No’, inform the program administrator immediately in Step 2 and document any discussions and the resulting action(s) in
Step 3.
Survey Evidence
Family Surveys
Teaching Staff Surveys
1
Are the returned NAEYC surveys present? (either
paper or digitally)
Yes
No
Yes
No
2
Are the NAEYC Survey Summary Sheets compiled
(either paper or digitally)?
Yes
No
Yes
No
3
Was the NAEYC Self-Assessment version used?
Yes
No
Yes
No
4
Complete a spot check: Does the number of returned
surveys present appear to match the number of
returned surveys reported on Summary Sheet?
Yes
No
Yes
No
5
Are all pages within the Summary Sheet complete?
(FS: 2 pages; TSS: 4 pages)
Yes
No
Yes
No
6
Complete a spot check: Responses to questions add
up to the number of surveys returned. (No questions
left blank.)
Yes
No
Yes
No
Step 2: Evidence Check Results. Check one of the following boxes.
Evidence Check Results
The program’s NAEYC Family Surveys and Teaching Staff Surveys and Survey Summaries appear to
be complete and accurate.
The Program Administrator was informed at ____________ (time) of potential problems with survey
evidence, and an explanation of the next steps was noted in Step 3 below.
Step 3: Document Next Steps (if applicable).
Document Next Steps
In this section, describe the missing or incomplete component(s) and document any discussions. Note: For
programs with multiple sites, if individual results from the different sites were collected, they must be
combined onto one summary sheet.
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Outdoor Learning Environment Form
ASSESSOR: During the program orientation tour, ask about and make note of any outdoor space(s) used at least
once a week by each group selected for observation. Complete the table below according to instructions below.
If all groups do not go outside, or if all groups do not use outdoor space(s) at least once a week, check Box 1.
If any individual groups do not go outside, or do not use outdoor space(s) at least once a week, list the group
numbers in Box 2. Verify that all randomly selected groups are accounted for.
Box 1:
Box 2:
THIS PROGRAM DOES NOT GO OUTSIDE
(NO OUTDOOR PLAY, INCLUDING WALKS).
THE FOLLOWING GROUPS DO NOT GO OUTSIDE:
Instructions
Include a brief description of each of the outdoor learning environments. This may include a private or public playground,
field, footpath or sidewalk, or parking lot.
An “area” could also be specific parts of a playground or other outdoor space that a particular group uses.
After identifying discrete areas and the groups that use them, ask: “Is there equipment for outdoor use in this area
that is stored in a shed, closet, or rolling cart”? If so, identify which areas utilize which equipment, and ask
permission to access the storage space (e.g., have them unlock sheds).
Outdoor Learning Environments used by this program:
Area 1
Area 2
Area 3
Area 4
Area 5
Area 6
Area 7
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Group(s) Using Area
(by Group Number)
Safety Concerns Report Form
Please note that the following environmental safety concerns were
observed during your program’s visit. The items listed may have been
considered in the rating of criteria. If children were found to be at risk of
immediate harm assessors would have intervened and noted the failure of
a Required Criterion.
NO ENVIRONMENTAL SAFETY CONCERNS WERE NOTED.
THE FOLLOWING ENVIRONMENTAL SAFETY CONCERNS WERE NOTED:
Indoor Environmental
Safety Concerns:
Location(s) & Explanation(s)
Furniture/Equipment:
unsecured furniture; disrepair; sharp,
pinch, and catch points
Choking/Strangulation:
dangling blind or electrical cords; small
toys and items accessible to infants
and/or toddlers
Tripping:
unsecured electrical cords or rugs;
uneven flooring
Entrapment:
play equipment
Infant Sleep Environment:
soft items in cribs or in rest equipment
for infants < 12 months old
Miscellaneous Items:
uncovered electrical outlets; cleaning
solutions, small appliances, or
purses/personal items accessible
Outdoor Environmental
Safety Concerns:
Location(s) & Explanation(s)
Equipment:
catch, pinch, or crush points; sharp
corners/edges; disrepair
Environmental:
poisonous plants; debris; bodies of
water accessible; insufficient drainage
Tripping:
curbs or uneven surfacing in running
paths
Entrapment:
fences, play equipment
A copy of this form will be returned to the NAEYC Academy along with other visit materials. Evidence has
already been rated; therefore no documentation of follow-up by programs is requested nor will be accepted.
However, NAEYC requests that your program take immediate corrective action to address the environmental
safety concerns noted. This includes, if applicable, notifying any third parties responsible for listed safety
concerns by providing them with a copy of this form with a request that they take immediate action.
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Visit Signature Form
Program Administrator:
I verify that I have reviewed the Visit Schedule (as hand-amended, if necessary) and that it
reflects the times and tasks of the actual visit to the best of my knowledge.
I verify that I was provided the opportunity to review the Missing Evidence Request Form
(MERF) and was provided the appropriate amount of time (as listed in protocol) to locate the
requested evidence listed (if applicable). I understand that the MERF is only used to request
missing evidence and that no additional documentation was requested for evidence that was
presented but did not meet the requirements of a criterion.
I affirm that I received notification from the assessor(s) of any possible violations of Required
Criteria, or was informed that there were no possible violations, based upon evidence reviewed
or observed during the visit. I affirm that I was provided with an opportunity to respond in writing
to the cited evidence, and I was provided with additional forms for the purpose of follow-up
documentation, if applicable, as indicated on the Required Criterion Report Form. I affirm
that I understand that (where relevant) I must send the Scope and Severity Response Form
and additional information related to any possible violations of required criteria within five
business days (30 business days for Required Criterion 5.A.03; 60 days for Required Criterion
5.A.12.a for infant sleep equipment) of receipt of the packet.
I verify that I have reviewed the Safety Concerns Report. If concerns were listed, I agree on
behalf of the program to take immediate corrective action to address any safety concerns noted
and/or notify any responsible third parties. I understand that evidence has already been rated
and therefore no further documentation of follow-up will be accepted by the NAEYC Academy.
I verify that I identified the outdoor learning environments used at least once a week by the
groups selected for observation on the Outdoor Learning Environment Form during the
Orientation Meeting, prior to the observations.
I affirm that I have reviewed the Evidence Check Form. If there were any noted concerns
addressed in the Evidence Check Form regarding the Family and/or Teaching Staff Surveys, I
affirm that I was notified of these concerns following the Orientation Meeting and was provided
the opportunity to gather the necessary documentation, as allowable within written protocol. In
the case that a Verification Visit was conducted, I was informed that this form is Not Applicable.
I affirm that all visit procedures as described in the Process Verification Form were
completed. I affirm that no conflict of interest exists between myself and the NAEYC
Assessor(s). I understand that the NAEYC Academy reserves the right to contact the
appropriate authorities if anything is observed that could jeopardize the health and safety of
any child enrolled at this program.
______________________________________
(Print Full Name)
__________________________________________
(Title)
Signature _____________________________________________
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Date: ____________________
Assessor(s):
I (we) verify that I (we) have reviewed and provided the program administrator a copy of the
Visit Schedule (as hand-amended, if necessary) and that it reflects the times and tasks of the
actual visit to the best of my (our) knowledge.
I (we) affirm that I (we) provided the program administrator the opportunity to review the
Missing Evidence Request Form (MERF) and provided the program administrator an
appropriate amount of time, as listed in protocol, to locate the missing evidence listed on the
MERF.
I (we) affirm that I (we) notified the program administrator of any possible violations of Required
Criteria, or that there were no possible violations, on the Required Criterion Report Form
based upon evidence reviewed or observed during the visit. I (we) affirm that I (we) described all
possible failed evidence to the best of my (our) ability, and provided the program administrator
with an opportunity to respond in writing to the cited evidence. Where relevant, I (we) directed
the program administrator to the Scope and Severity Response Form and additional forms for
the purpose of follow-up documentation.
I (we) verify that I (we) have reviewed the Safety Concerns Report, with the program
administrator, and discussed any noted safety concerns on the Safety Concerns Report.
I (we) verify that I (we) discussed with the program administrator the outdoor areas used at least
once a week by the groups selected for observation on the Outdoor Learning Environment
Form during the Orientation Meeting, prior to the observations. I (we) verify that I (we) assessed
the described areas for each applicable group throughout the visit.
I (we) affirm that I (we) have reviewed the Evidence Check Form with the program
administrator. If there were any noted concerns addressed in the Evidence Check Form
regarding the Family and/or Teaching Staff Surveys, I (we) affirm that I (we) notified the
program administrator of these concerns following the Orientation Meeting and provided the
opportunity to gather the necessary documentation, as allowable within written protocol. In the
case that a Verification Visit was conducted, I (we) explained that this form is Not Applicable.
I (we) affirm that all visit procedures as described in the Process Verification Form were
properly followed and completed during the visit. I (we) affirm that my (our) commitment to
maintaining confidentiality regarding all information about this program during the visit, except
as required by law.
Lead Assessor:______________________________________
Assessor ID #
Signature _____________________________________________
Date:
Additional Assessor(s):
Assessor ID #(s)____________
(Print Full Name)
Signature(s):
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(Print Full Name)
Date:
Program ID:
First Aid/CPR Acknowledgment Form
This form is being submitted to the program administrator for one or more of the following reasons
(check all that applies):
1.
No Certified Staff in a Group. On the day of the visit, there was at least one group in which all
staff members had neither first aid nor CPR (with Infant/Child or Pediatric component) training.
2.
No CPR (with Infant/Child or Pediatric component) Documented. On the day of the visit, in
at least one group in the Program, none of the staff present in the group(s) had CPR with an
infant/child or pediatric component, but did have First Aid training.
a.
On the day of the visit, the Program had at least one staff member present with each group of
children who had a certificate showing current first aid training, BUT the documentation did
not show clearly that the training included current CPR (with Infant/Toddler or Pediatric
component) training and did not have training in Infant/Child or Pediatric Rescue Breathing
and Blocked Airway in lieu of CPR.
b.
On the day of the visit, the Program had at least one staff member present with at least one
group of children who had a certificate showing current first aid training, which included
training in Infant/Child or Pediatric Rescue Breathing and Blocked Airway in lieu of CPR.
(If this box is checked, you must check box 2 on page 2 of this form.)
3.
No First Aid Training Documented. On the day of the visit, the Program had at least one staff
member present with each group of children who had documentation showing current CPR (with
Infant/Child or Pediatric component) training, BUT the Program had one or more groups in which no
staff member present had a certificate showing current first aid training.
If any of these reasons apply, the Missing Evidence Request Form (MERF) included a list of the staff for whom no
evidence was seen (no first aid training documentation and/or no CPR (with Infant/Child or Pediatric component)
training). If the administrator could not provide additional evidence when returning the MERF, then the assessor rated
criterion 5.A.03 as NOT MET on the Program Portfolio and GOE tools. The assessor also completed the Required
Criterion Report Form. The administrator was directed to this acknowledgment form in the Administrator Information
Packet during the Closing Meeting, and received a copy of this form in the Visit Completion Packet following the site
visit. The administrator may sign the acknowledgment at a later date, when all conditions have been met. Programs that
have completed First Aid training with a Pediatric Rescue Breathing component in lieu of CPR prior to April 1, 2014 may
sign the acknowledgment form with the understanding that appropriate CPR training must be in place as of January 1,
2015. The completed form can be faxed or emailed to NAEYC within 30 days of the site visit (see below).
Additional Guidance on NAEYC Criterion 5.A.03. Note that the entire course content (first aid or CPR) does not have
to be pediatric, but it must include some content specific to infants and/or children. See these sources for more
information:
□
American Academy of Pediatrics: http://www.pedfactsonline.com/about_PedFACTS.cfm
□
American Red Cross: http://redcross.org
□
National Safety Council:
http://www.nsc.org/products_training/Training/firstaidandCPR/Pages/FirstAidTrainingPrograms.aspx
□
American Heart Association: http://www.americanheart.org (select CPR & ECC)
□
Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child
Care: http://nrckids.org/CFOC3/index.html
22 of 28
First Aid/CPR Acknowledgment Form
On behalf of
20____, I confirm that the following is true:
(the “Program”) on this
day of
,
Check the box that applies to your Program. (If box 2.b on page one is checked, you must select box 2 on this page.)
By signing this form, the Program agrees to the Applicable Statement.
1.
Each group of children has at least one staff member present at all times who has completed first aid training
and a CPR course including infant and/or Child CPR.
OR
2.
For any group of children in which teaching staff have completed first aid training with a pediatric rescue
breathing and blocked airway component in lieu of pediatric or infant and/or child CPR prior to April 1, 2014, I
acknowledge and understand that as of January 1, 2015 at least one staff member who is always present with
each group of children must complete a CPR course including infant and/or child CPR in addition to
maintaining current first aid.
All remaining groups of children have at least one staff member present at all times who has completed first aid
training and a CPR course including infant and/or child CPR.
I acknowledge and understand that compliance with current first aid training and a CPR course including infant and/or Child
CPR is a mandatory requirement for the Program to be in compliance with NAEYC Required Criterion 5.A.03. If granted
accreditation, I acknowledge and understand that it is the Program’s responsibility to remain in full compliance with NAEYC
Required Criterion 5.A.03, and to maintain evidence documenting full compliance if applicable. It is also the Program’s
responsibility to report to the NAEYC Academy any failure to meet this required criterion throughout my term of
accreditation. I understand that failure to meet this required criterion throughout any term of accreditation will result in the
revocation of the Program’s NAEYC Accreditation. I further understand that if accreditation is revoked , the Program is no
longer in compliance with NAEYC’s accreditation policies and procedures and must immediately terminate all use of the
NAEYC name, logo, and trademarks, and promptly remove all references to NAEYC and NAEYC accreditation from
Program materials and websites.
The Program shall indemnify, defend and hold harmless, and hereby releases and discharges, NAEYC, its affiliates,
directors, officers, members, and their respective agents and employees from and against any and all claims, liabilities,
demands, suits, costs, expenses (including attorney’s fees) and judgments of whatever nature and description which may
result from or are in any way related to this refusal and/or revocation of the Program’s accreditation.
I hereby represent to NAEYC that I am a duly authorized representative of the Program and have full right to make this
Acknowledgment and Confirmation. I have read carefully this Acknowledgment and Confirmation regarding current first
aid training and current CPR (with Infant/Toddler or Pediatric component) and am signing voluntarily, intending to be legally
bound.
Signature of authorized administrator
Name (please print)
Title
Date
Program Name
NAEYC Program ID Number
This form and related documentation may be sent by e-mail with an electronic signature to [email protected]
with a subject line of “First Aid/CPR Acknowledgment Form”. Be sure to include your Program ID number. We look
forward to receiving your documentation and completing the processing of the visit data in preparation for an
accreditation decision.
If you have any questions after reviewing this acknowledgment form, you may contact the Academy at 800-424-2460 or
send an email to: [email protected].
23 of 28
Infant Sleep Equipment Acknowledgment Form: Cover Page
Required Criterion 5.A.12, Indicator ‘a’ addresses safe sleep practices for infants 12 months or younger. The
criterion states that programs serving infants are “placed on their backs to sleep on a firm surface
manufactured for sale as infant sleep equipment that meet the standards of the United States Consumer
Product Safety Commission”. “Infant sleep surfaces” include cribs, equipment other than cribs (e.g., play yards,
floor beds), or a combination of both. All programs serving infants will be required to sign the Infant Sleep
Equipment Acknowledgment Form regardless of the type of infant sleep equipment used at the program.
Documentation of crib or “other” sleep equipment compliance will not be requested by NAEYC and will not be
accepted as evidence for Required Criterion 5.A.12, Indicator ‘a’.
Prior to a site visit, programs may sign the acknowledgment form and include it in the Program Portfolio1 for
assessor review during the visit. The assessor will make a copy of the form to return to the NAEYC Academy.
If the assessor does not see a signed copy of this form, she or he will request on the Missing Evidence
Request Form (MERF) that the administrator sign the form electronically during the visit. If the administrator
chooses not to sign the Infant Sleep Equipment Acknowledgment Form during the visit, the assessor will
indicate that 5.A.12, Indicator ‘a’ may be possibly failed on the Required Criterion Report Form (RCRF).
If the Infant Sleep Equipment Acknowledgment Form was not signed before or during the visit, the assessor
will include an additional, unsigned copy of the acknowledgement form in the Visit Completion Packet sent via
email to the administrator after the visit. The program will have 60 days to complete and submit the
acknowledgement form. However, the accreditation decision process cannot be completed until the
acknowledgement form has been received. Note also that if a program does not sign the form before or during
their site visit, NAEYC may not be able to issue their Accreditation Decision Report within three months
following the visit, or before the program’s Renewal deadline (if applicable).
Additional Information on Infant Sleep Equipment
□ U.S. Consumer Product Safety Commission (CPSC), The New Crib Standard: Questions and Answers
http://www.cpsc.gov/onsafety/2011/06/the-new-crib-standard-questions-and-answers
□ U.S. Consumer Product Safety Commission (CPSC), Play Yards: New Safety Rule to Take Effect
http://www.cpsc.gov/onsafety/2013/02/play-yards-new-safety-rule-to-take-effect/
□ Caring for Our Children, 3rd edition (CFOC3): Standard 3.1.4.1: Safe Sleep Practices and SIDS
http://cfoc.nrckids.org/StandardView/3.1.4
□ Caring for Our Children, 3rd edition (CFOC3): Standard 5.4.5. Sleep and Rest Areas
http://cfoc.nrckids.org/StandardView/5.4.5
Submission Instructions. NAEYC prefers to receive this documentation through email, but surface mail submissions are
acceptable. Be sure to include your Program Name and ID number in the subject line. NAEYC will acknowledge receipt of
your forms, so please re-contact us if you do not receive an acknowledgment after submission.
Email: [email protected]
Mail: NAEYC Academy Quality Assurance
1313 L Street, Suite 500 NW
Washington, DC 20005
24 of 28
Infant Sleep Equipment
Acknowledgment Form
On behalf of
I confirm that the following is true:
(the “Program”) on this
Program ID:
day of
, 20
,
Type of infant
sleep
equipment
Check the box that applies to the infant sleep equipment used by the Program for infants 12 months and
under. If the Program uses both types of infant sleep equipment (cribs and other), check both boxes. By
signing this form, the Program agrees to these statements (if applicable).
Cribs
I am aware of the U.S. Consumer Product Safety Commission (CPSC) crib standards (#16 CFR part 1219 for
full-size cribs; #16 CFR part 1220 for non-full-size cribs) revised December 2010. I further confirm that the
Program is currently providing cribs with a firm surface manufactured for sale as infant sleeping equipment that
meets the current CPSC standards for each infant who may be sleeping at the same time at the program.
Other
To the best of my knowledge, all other sleep equipment (not cribs) used at the Program are approved as “a firm
surface manufactured for sale as infant sleep equipment that meets the standards of the United States Consumer
Product Safety Commission.”
“Other” sleep equipment includes all infant sleep equipment other than cribs, for example, play yards and floor beds.
I acknowledge and understand that compliance with current CPSC infant sleep equipment standards is a mandatory requirement for
the Program to be in compliance with NAEYC Required Criterion 5.A.12, Indicator ‘a’. If granted accreditation, I acknowledge and
understand that it is the Program’s responsibility to remain in full compliance with NAEYC Required Criterion 5.A.12, Indicator ‘a’,
and to maintain evidence documenting full compliance if applicable. It is also the Program’s responsibility to report to the NAEYC
Academy any failure to meet this required criterion throughout any term of accreditation. I understand that failure to meet this required
criterion throughout any term of accreditation will result in the revocation of the Program’s NAEYC Accreditation. I further understand
that if accreditation is revoked, the Program is no longer in compliance with NAEYC’s accreditation policies and procedures and must
immediately terminate all use of the NAEYC name, logo, and trademarks, and promptly remove all references to NAEYC and NAEYC
Accreditation from program materials and websites.
The Program shall indemnify, defend and hold harmless, and hereby releases and discharges, NAEYC, its affiliates, directors, officers,
members, and their respective agents and employees from and against any and all claims, liabilities, demands, suits, costs, expenses
(including attorneys’ fees) and judgments of whatever nature and description that arise out of or in connection with the Program’s
infant sleep equipment, CPSC crib standards, Required Criterion 5.A.12, Indicator ‘a’, and/or any revocation of the Program’s
accreditation related to infant sleep equipment.
I hereby represent to NAEYC that I am a duly authorized representative of the Program and have full right to make this
acknowledgment and confirmation. I have read carefully this Acknowledgment regarding infant sleep equipment and am signing
voluntarily, intending to be legally bound.
Signature of authorized administrator
Name (please print)
Title
Date
Program Name
NAEYC Program ID Number
This form may sent by e-mail with an electronic signature to [email protected] with a subject line of “Infant Sleep Equipment
Acknowledgment Form”. Be sure to include your Program ID number. We look forward to receiving your documentation and completing
the processing of the visit data in preparation for an accreditation decision.
If you have any questions after reviewing this acknowledgment form, you may contact the Academy at 800/424-2460or send an email to:
[email protected].
25 of 28
Program ID:
License-Exempt Acknowledgment Form
I acknowledge that
, 20
education programs in the state of
compliance with the following:
(the “Program”) on this
day of
is exempt from licensing and regulation requirements for early childhood care and
, and is not currently licensed or Regulated. I acknowledge
•
The Program’s administrator has reviewed the state’s licensing requirements.
•
The board chair, president or owner of the Program has reviewed the state’s licensing requirements.
•
The Program is voluntarily in compliance with the state’s licensing requirements.
•
Upon registration of children in the Program, my program provides families with a copy of the state’s licensing
requirements, informs families that the Program is license-exempt, and informs families that the Program is voluntarily in
compliance with the state’s licensing requirements.
•
The Program has documentation of fire and health inspections.
•
The Program has completed a criminal background check on all staff and has complied with state and federal law concerning
background checks. In addition, the Program employs no individual convicted of a crime involving sexual abuse or child abuse
or neglect in compliance with the Program’s local, state and federal laws.
If I qualify as being licensed-exempt I acknowledge and understand that it is my responsibility to maintain evidence documenting full
compliance with the statements above for the Program to be in compliance with NAEYC Required Criterion 10.B.04. If granted
accreditation, I acknowledge and understand that it is the Program’s responsibility to remain in full compliance with NAEYC
Required Criterion 10.B.04, and to maintain evidence documenting full compliance if applicable. It is also the Program’s
responsibility to report to the NAEYC Academy any failure to meet this required criterion throughout any term of accreditation. I
understand that failure to meet this required criterion throughout any term of accreditation will result in the revocation of the
Program’s NAEYC Accreditation. I further understand that if accreditation is revoked, the Program is no longer in compliance with
NAEYC’s accreditation policies and procedures and must immediately terminate all use of the NAEYC name, logo, and trademarks,
and promptly remove all references to NAEYC and NAEYC accreditation from Program materials and websites.
The Program shall indemnify, defend and hold harmless, and hereby releases and discharges, NAEYC, its affiliates, directors, officers,
members, and their respective agents and employees from and against any and all claims, liabilities, demands, suits, costs, expenses
(including attorney’s fees) and judgments of whatever nature and description which may result from or are in any way related to this
refusal and/or revocation of the Program’s accreditation.
I hereby represent to NAEYC that I am a duly authorized representative of the Program and have full right to make this
Acknowledgment. I have read carefully this License-Exempt Acknowledgment Form and am signing voluntarily, intending to be
legally bound.
Name of authorized administrator (please write)
Title
Signature of authorized administrator
Date
Program Name
NAEYC Program ID Number
If this acknowledgment form cannot be collected or executed digitally on the day of the visit, the form and related documentation
may be emailed with an electronic signature to NAEYC within five business days to [email protected] with a subject line
of “License-Exempt Acknowledgment Form”. Be sure to include your Program ID number within this form. We look forward to
receiving your documentation and completing the processing of the visit data in preparation for an accreditation decision.
If you have any questions after reviewing this acknowledgment form, you may contact the Academy at 800-424-2460 or send an
email to: [email protected].
License-Exempt Acknowledgment Form
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Effective October 2015
Next Steps and the NAEYC Accreditation Decision: Accreditation Visit
You’ve just finished your Accreditation Visit! What’s Next?
Your program has completed a major part of the NAEYC Accreditation process, and we're very happy
that you've come this far. While you're waiting for the accreditation decision, be confident that your
hard work illustrates your program's commitment to serving young children. Thank you very much for
pursuing NAEYC Accreditation and supporting the mark of quality in early childhood education.
Your feedback is valuable
Please click on the following link and complete the Administrator’s Evaluation: Accreditation Visit
form. The Administrator’s Evaluation should be submitted within five days of receiving the Visit
Completion Packet after the Accreditation Visit. This is an important process that provides an
opportunity for you and your program staff to identify any concerns with the Accreditation Visit. All
evaluations are received and reviewed by the Academy's Quality Assurance unit; your feedback will
not have an impact on your accreditation decision.
Additionally, the NAEYC Academy would love to hear all about your experiences throughout the
process; send an email to [email protected].
What does the NAEYC Academy do after the visit?
After the accreditation visit, the assessor sends the visit materials to NAEYC. At this point the
assessor's role ends. Your program resumes communicating directly with NAEYC Academy staff. The
NAEYC Academy first verifies that all procedures were followed and all information is complete and
accurate. Then the assessment tools are scored and an accreditation decision is made.
If the assessor determined that there was a possible violation of any required criterion, the program
receives specific instructions regarding follow-up in the Visit Completion Packet email sent soon after
the visit is done.
Within three months following your accreditation visit you will receive the Accreditation Decision
Report. The Accreditation Decision Report includes a summary of scores for each of the ten NAEYC
Early Childhood Program Standards and the percentage of criteria met for each group observed. The
report also identifies areas for ongoing improvement.
There are four possible NAEYC Accreditation Decision outcomes:

Accredited: A program achieves NAEYC Accreditation when it demonstrates it has met all
accreditation requirements. The program receives a certificate, information on maintaining
accreditation throughout the five-year term, and other related materials.

Accredited with Additional Verification: The NAEYC Academy has identified an area of
concern related to the program's full compliance with a Required Criterion. While this concern
was not determined to be a serious violation, additional verification is needed to determine the
program's capacity to maintain the Required Criterion over time.

Deferred: NAEYC Accreditation is deferred when a program has not met all accreditation
requirements, but shows evidence that it could achieve accreditation in a defined period of time.
For detailed information on re-entering the accreditation process please refer to the NAEYC
website.
 Denied: NAEYC Accreditation is denied when a program has not met all accreditation
requirements, and does not show evidence that it can achieve accreditation in a defined period of
time OR fails to meet a Required Criterion. For detailed information on re-entering the accreditation
process please refer to the NAEYC website.
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© 2015. 27National
Association for the Education of Young Children. This form can be reproduced for use by programs
seeking or maintaining NAEYC Accreditation. All other rights reserved.
Next Steps and the NAEYC Accreditation Decision: Accreditation Visit
To achieve NAEYC Accreditation:
Meet ALL Required Criteria
80% of assessed criteria in each standard
70% of assessed criteria in each group observed
Sample Accreditation Decision Report
Percentage of Met Criteria
By Program Standard:
1. Relationships
2. Curriculum
100%
81%
Percentage of Met Criteria For
Each Classroom Observed:
Class A
Class B
75%
88%
AREAS FOR ONGOING IMPROVEMENT BY PROGRAM STANDARD
2. CURRICULUM
A curriculum that draws on research assists teachers in identifying important concepts and skills as well as effective
methods for fostering children’s learning and development. When informed by teachers’ knowledge of individual
children, a well-articulated curriculum guides teachers so they can plan learning experiences that foster children’s
growth across a broad range of developmental and content areas. A curriculum also helps ensure that the teacher is
intentional in planning a daily schedule that (a) maximizes children’s acquisition of desired knowledge and skills
through the effective use of time and materials and (b) offers opportunities for children to learn through play and
structured activities individually and in groups according to their developmental needs and interests.
Topic area(s) for ongoing improvement:
2.A
Curriculum: Essential Characteristics
2.B
Areas of Development: Social-Emotional Development
Reading your Accreditation Decision Report
To ensure continued success, the program should take a broad approach to ongoing program
improvement by focusing on the Topic Areas within the Standards that are in need of improvement
rather than individual criteria within the Topic Areas. If a program receives a ‘Defer’ or ‘Deny’
decision, the program will also receive specific feedback regarding group performance as well as
criterion-specific feedback in each standard.
When reviewing criteria within a Topic Area, be sure to consider which source(s) of evidence were
used to rate that Topic Area. Use the Sources of Evidence checklist online on TORCH
www.naeyc.org/torch .
Your Accreditation Decision Report will also include a descriptive statement about the quality of your
Program Portfolio and Classroom Portfolio to help guide your program improvement.
Update NAEYC
The Self-Report form and 72-Hour Notification form are mechanisms you should use if your program
encounters a variety of changes throughout the Accreditation process and the 5-year term of
accreditation. For more details about when and how to notify NAEYC about changes that affect your
program, visit http://www.naeyc.org/academy/pursuing/changes .
Thank you!
Thank you for welcoming your assessor(s) and participating in the visit process. This step
strengthens the reliability of the accreditation system so that all stakeholders have a greater
appreciation for the investments programs make to improve, so that children benefit from high-quality
early learning experiences. For more help, contact us at [email protected] or
(800) 424-2460 to contact the NAEYC Academy.
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© 2015. 28National
Association for the Education of Young Children. This form can be reproduced for use by programs
seeking or maintaining NAEYC Accreditation. All other rights reserved.