Form CFS-CCL-DAK 5622, Parent Evaluation of Child Care Services Form – Dakota County, MN

Form CFS-CCL-DAK 5622, the Parent Evaluation of Child Care Services Form, is a questionnaire from Dakota County Social Services Child Care Licensing on which a parent rates a family child care provider and describes the home's strengths and concerns.

The form is headed Parent Evaluation of Family Child Care Home and carries the code CFS-CCL-DAK 5622 (10/2017). It collects three kinds of information:

• The provider and your connection to the home: the provider's name and city, the date, whether you currently have a child enrolled, the children's ages, how long you have used the home, whether the provider's license is posted and how many children the provider is licensed to care for at one time.
• Ratings: 14 statements scored from 5 (Strongly Agree) to 1 (Strongly Disagree), with N/A for not applicable. They cover individual attention, daily activities, materials, outdoor time, meals, supervision, sleep space, guidance of behavior, the number and ages of children in care, toys and equipment, diaper changing, communication, and overall quality, environment, safety and hygiene.
• Written answers: the main reason you left, if you no longer use the home; the provider's strong points; any concerns about the provider's physical or emotional health and well-being that affect the ability to care for children; possible improvements; and additional comments.

You return the completed evaluation to Dakota County Child Care Licensing by email or mail. The form states that licensing staff are required by state statute to follow up on any information that may constitute a licensing violation.

Parents who have a child enrolled in a family child care home, or who used one in the past, use this form to give Dakota County Child Care Licensing their evaluation of that provider. The questions are written for both groups: question 1 asks whether you currently have a child enrolled, question 3 asks how long you use or used the home, and question 15 applies only if you are no longer using the home.

Each form covers one provider. The top of the page asks for the provider's name and city, and the provider's city is also what you enter in the email Subject line.

Nothing printed on the form makes completing it mandatory, and it names no one who may sign for you: the signature block asks for your own name, the date and your phone number. If you would like to talk with a licensor about a provider before or instead of writing, the form gives the phone number 952-891-7400.

Complete the form whenever you want to give Dakota County Child Care Licensing your evaluation of a family child care provider, whether your child is enrolled now or you have left. No due date is printed on it; the form asks for the date you complete it.

Keep in mind that the licensing staff are required by state statute to follow up on any information you provide that may constitute a licensing violation, so a concern you describe on the form can lead to follow-up by the agency. If you would rather discuss a provider with a licensor directly, call 952-891-7400.

You can return the completed evaluation by email or by mail.

• Email: send it to [email protected]. Enter the provider's city in the "Subject" line, as the form instructs.
• Mail: send it to Dakota County Child Care Licensing, 14955 Galaxie Avenue, Apple Valley, MN 55124.

The signature block has a box that reads "By checking this box, you are signing this form electronically," followed by your name, the date and your phone number. If you would rather talk with a licensor about the provider, the form gives the phone number 952-891-7400. The form names no other submission channel. FillingPDF lets you fill out and download the PDF; submission follows the channels above.