H.A.P.P.Y.
HOMES
Trumbull County’s Helping Association for
Professional Providers of Young Children
Barb McVicker, President:
330-372-6133; Mara Mathy,
Vice President: 330-876-1308;
MaryBeth Bush,
Secretary/Treasurer:
330-847-1957
MEMBERSHIP APPLICATION
Date___________
P
er
s
o
n
al
In
fo
r
m
at
io
n
Name__
_______
_______
_______
_______
_______
_______
_______
_
Address
_______
_______
_______
_______
_______
_______
_______
__
City___
______
______
______
____Sta
te_____
______
__Zip
______
___
Phon
e___
___
___
___
___
___
___
___
__
P
R
O
G
R
A
M
I
N
F
O
R
M
A
TI
O
N
Childcar
e/presch
ool
name__
______
______
______
______
______
____
Ages
accepte
d in
your
program
______
______
______
______
______
__
Hours
and
Days of
operatio
n_____
______
______
______
______
_____
Circle all applicable: part time, full time, before/after school, drop-in
care,
Program description: include all special services, i.e. special needs, preschool
Offered, parent’s night out, etc._______________________________________
________________________________________________________________
County Certified: YES _______ NO ________
If certified, what county/counties _________________________________
Type of certification: Type
A _______Type
B________Limited________
Child Care Center:
YES______________
NO______________
If
center,
center
name___
_______
_______
_______
_______
_______
____
Address:_
___________________________
_______________
Position:_
___________________________
_______________
Other:__________________________________________
P
R
O
VI
D
E
R
I
N
F
O
R
M
A
TI
O
N
Experience____________________________________
Level of Education: circle: high
school graduate, some college,
college degree
(in
what___
_______
__), in
CDA
program,
awarded
CDA,
CDA
renewal
TOTAL TRAINING HOURS__________________________________
Best time to accept phone calls_____________________________________
Best day/time to attend meetings____________________________________
DUES: $25.00
per year (year
runs September
1 to August 31).
All funds are
directly used for
our members
and to improve
childcare and
promote
childcare issues
for ALL
children.