If you require assistance in completing the application, please contact the RIAEYC office at 401-739-6100 to schedule application support.

1. APPLICANT INFORMATION:

Date of Application:(Required)

County of Residence:(Required)

County Where You Work:(Required)

Full Name (as shown on your income tax return):(Required)

First Middle Last

Previous/Maiden Name (if applicable):

Last

Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone:

Cell Phone:(Required)

Extension:

Email Address:(Required)

Date of Birth:(Required)

Gender (optional):

Ethnicity (optional):

Preferred Language:

English

Spanish

2. EDUCATION BACKGROUND

Degree(s) Earned (check all that apply):(Required)

Current CDA Credential

Coursework completed but no degree earned

Associate’s degree

Bachelor’s degree

Master’s degree

Coursework Major

Coursework College Attended

Associate's Major

Associates College Attended

Year Graduated

Bachelor's Major

Bachelor's College Attended

Year Graduated

Master's Major

Master's College Attended

Year Graduated

Have you completed any additional education that is not listed above?:(Required)

Yes

If yes, please explain:

How will you submit your official transcript?:(Required)

Emailed to [email protected] directly from the school

Mailed to WAGE$ (501 Centerville Road Suite 202) directly from the school

I will drop off the transcript in a school sealed envelope to WAGE$ (501 Centerville Road Suite 202)

CDA and College Transcript: I will attach my CDA below and submit my college transcript via one method list above

Current CDA Only: I have attached a copy of the certificate from the Council below.

I have an International Transcript Evaluation

Please Specify Here:(Required)

Emailed to [email protected] directly from the school

Mailed to WAGE$ (501 Centerville Road Suite 202) directly from the school

I will drop off the transcript in a school sealed envelope

Upload a copy of your up-to-date CDA credential OR your International Transcript Evaluation:(Required)

Max. file size: 128 MB.

Have you or are you currently participating in:(Required)

TEACH

LearnERS

Rhode Island Early Childhood Registered Apprenticeship

I have not participated in, nor am I currently participating in, those programs.

3. OWNERSHIP STATUS

Current Hourly Rate(Required)

Ownership Status:(Required)

I own my own Family Child Care Business and work as an educator/operator. I do not own any other child care business.

I am employed by my child care program. I do not own any child care facilities.

Applicant's Role:(Required)

Lead Teacher - Employees in a child care center who are directly involved in the care, development, and education of children ages 6 weeks to 5 years, working 10-40 hours per week. Must be on the payroll of a child care center, family child care home, or group family child care home. Must be at least 18 years old. They cannot hold dual roles within the center. (e.g., Director & Lead Teacher, or Education Coordinator & Floater)

Assistant Teacher - Employees in a child care center who are directly involved in the care, development, and education of children ages 6 weeks to 5 years, working 10-40 hours per week. Must be on the payroll of a child care center, family child care home, or group family child care home. Must be at least 18 years old. They cannot hold dual roles within the center. (e.g., Director & Lead Teacher, or Education Coordinator & Floater)

Family Child Care Provider - Licensed residential settings where care is provided for up to 6 children, or up to 8 children with an approved assistant. This does not include informal arrangements among neighbors, relatives, or occasional child care without compensation. Directly involved in the care, development, and education of children ages 6 weeks to 5 years, working 10-40 hours per week. Must be at least 18 years old.

Floater - Employees in a child care center who are directly involved in the care, development, and education of children ages 6 weeks to 5 years, working 10-40 hours per week. Must be on the payroll of a child care center, family child care home, or group family child care home. Must be at least 18 years old. They cannot hold dual roles within the center. (e.g., Director & Lead Teacher, or Education Coordinator & Floater)

Employer/Director's Name(Required)

First Last

If you are the owner, you are authorized to enter your name here.

Employer/Director's Email:(Required)

Your employer/director will receive an email link to verify employment information. Please advise them that this email may go to their spam folder. If you are the owner, you are required to enter your email here.

Employer/Director's Phone Number:(Required)

Program Name as it appears on your Employer's DHS License(Required)

Program Mailing Address(Required)

Date you became owner:(Required)

Single Family Child Care Home: Verify your income by submitting your most recent 1040 Tax Form, all supporting schedules and the W2 Form (if you file jointly, the W2 forms from both parties must be submitted). Additional business documents may be requested if necessary. Please upload below.(Required)

Max. file size: 128 MB.

Please list site names here:

Multiple Site Ownership: Verify your income by submitting your most recent 1040 Tax Form, all supporting schedules and the W2 Form (if you file jointly, the W2 forms from both parties must be submitted). Additional business documents may be requested if necessary. Please upload below.(Required)

Drop files here or

Max. file size: 128 MB.

No Ownership: Please verify your income by uploading a copy of a recent paystub.(Required)

Max. file size: 128 MB.

How many total hours per week do you spend directly with children birth to 5?(Required)

Please enter a number greater than or equal to 1.

How many total hours do you work per week?(Required)

Please enter a number greater than or equal to 1.

Child Care WAGE$ RI requires all applicants to be registered with the Rhode Island Start Early System (RISES).

Enter Your Workforce ID:(Required)

Your Workforce ID number is required to complete your application.

Verify your registration by submitting a downloaded copy/screenshot of your registry profile. This must include your Workforce ID. Please upload below.(Required)

Max. file size: 128 MB.

5. PARTICIPATION AGREEMENT

By signing below you agree to the full agreement here

Signature(Required)

Application

If you require assistance in completing the application, please contact the RIAEYC office at 401-739-6100 to schedule application support.

1. APPLICANT INFORMATION:

2. EDUCATION BACKGROUND

3. OWNERSHIP STATUS

Child Care WAGE$ RI requires all applicants to be registered with the Rhode Island Start Early System (RISES).

5. PARTICIPATION AGREEMENT

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