Belonging Awards Application Form.

Association of Infant Mental Health in Tennessee is Proud to Present the Inaugural 2023 Belonging Awards! Please utilize this link to our website for glossary of terms, resources, research articles and referral services as you begin this process. We want to give every applicant the opportunity to get support BEFORE applying to ensure you are confident in your inclusion program and able to support the littles you serve. If you need direct assistance, please contact Hunter Hancock - Inclusion Coordinator at hunterh@aimhitn.org or 731-607-4449

Agency/Center Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

County

Phone

(###)

###

####

Contact Name

First Name

Last Name

What type of DHS Licensed Center is this?

Family

Group

Center

How does your program's philosophy promote inclusive practices?

How do your administrators and staff support the belonging of each child in your center?

How do administrators and staff practice an inclusive attitude and spirit valuing cultural, linguistic, and ability diversity?

Number of Full Time Employees

Number of Part Time Employees

Do you utilize student workers or volunteers?

Yes

Number of Multi-Racial Employees Currently Employed

Number of American Indian or Alaskan Native Employees Currently Employed

Number of Asian Employees Currently Employed

Number of Black Employees Currently Employed

Number of Hispanic or Latino Employees Currently Employed

Number of White Employees Currently Employed

Number of Children Enrolled Full Time

Number of Children Enrolled Part Time

Number of Multi-Racial Children Currently Enrolled

Number of American Indian or Alaskan Native Children Currently Enrolled

Number of Asian Children Currently Enrolled

Number of Black Children Currently Enrolled

Number of Hispanic or Latino Children Currently Enrolled

Number of Native Hawaiian or Pacific Islander Children Currently Enrolled

Number of White Children Currently Enrolled

Languages Spoken by Families at Home (List all that apply)

Number of children enrolled with Individualized Family Service Plans (IFSP)

Number of students who are receiving Childcare Certificates

Child care certificate means a certificate (that may be a check, or other disbursement) that is issued by a grantee directly to a parent who may use such certificate only as payment for child care services or as a deposit for child care services if such a deposit is required of other children being cared for by the provider, pursuant to § 98.30. Nothing in this part shall preclude the use of such certificate for sectarian child care services if freely chosen by the parent. For the purposes of this part, a child care certificate is assistance to the parent, not assistance to the provider; 45 CFR 98.2

What types of specialized training, credentials, or endorsements have you or your staff completed in regard to inclusion?

Belonging Awards Application Form.

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