On My Way Pre-K
Provider Application
This application must be completed fully and submitted to the Office of Early Childhood and Out of School Learning prior to enrollment as an On My Pre-K approved program.
Business Name or School District Name ______(If different from Program Name)
Pre-K Program Address: ______
City ______IN County ______Zip Code ______
Phone number (___) ______Fax number (____) ______
Email Address______
Primary Contact Name ______Title ______
REQUIRED ELIGIBILITY STATUS Check License/Registration/EX# Paths to QUALITY Auspice box (enter number in this box) (circle appropriate Level) Home Level 3 Level 4 Center Level 3 Level 4 Registered Level 3 Level 4 Ministry Public Level 3 Level 4 School Charter Level 3 Level 4 School Private Name of Accrediting Body: PES/CCDF Accredited Level 2 Level 3 Level 4 Approved School** **Please attach proof of accreditation from Accrediting Body and proof that accreditation includes the school’s Pre-K classrooms.
All OMWPK grants must have a match component of at least five percent (5%) but not more than fifty percent (50%) of the tuition for eligible or limited eligibility children under the prekindergarten pilot program. Match funds must be paid from donations, gifts, grants, bequests, and other funds received from a private entity or person, from the United States government, or from other sources (excluding funds from this grant and excluding other state funding).
Please check with county foundations, coalitions or other entities who may be available in your county to help provide this match. Please contact [email protected] if you have questions or need assistance. If your county does not provide match funds, you will be billed for each OMWPK child enrolled in your program.
On My Way Pre-K Provider Application 1/2020 On My Way Pre-K
Provider Application There are two different types of eligibility and reimbursement for On My Way Pre-K. All OMWPK grants are for children who will be 4 years-old (and not 5) by August 1 of the Pre-K year and a resident of Indiana. The following chart will define how many OMW children in each category your program can currently serve. This capacity may increase or decrease each year and can be monitored by the number of On My Way Pre-K provider forms you complete for families who wish to enroll in your program. Regular OMWPK Limited Eligibility OMWPK Eligibility • Family income 127% FPL • Family income up to 185% FPL • Parents in household working, going to • Parents in household working, going to school or school or attending job training attending job training OR parents receive SS Income or SSD Income Program Cost: • On My Way Pre-K grant payments are • On My Way Pre-K universal grant payments based based on county market rates OR the on limits of state funding per grant based on program’s cost per child of same age- attendance. whichever is less. • All grants solely funded by state funds. • All grants co-funded with federal and state • A minimum of 34 weeks/maximum of 46 weeks funds. Families meet CCDF eligibility. will be reimbursed with state funds • All grants are full time. • Match dollars 5% of grant amount - $6,800 full • Match dollars 5% of state funding only. time/3,400 part time. Program receive full Children attending 25 hours Children attending 25 hours or Reimbursement weekly provider $147.82/wk or more per wk: more per week: : payment receive ½ Children attending less than Children attending less than 25 weekly provider $ 73.91/wk 25 hours per wk: hours per week: payment OMWPK provider form must reflect your *** ALL LIMITED ELIGIBILITY GRANTS WILL RECEIVE weekly rate charged all families. THE SAME REIMBURSEMENT REGARDLESS OF **IF REGULAR OMWPK PROGRAM RATE IS LESS THAN COUNTY, PROVIDER TYPE, PTQ LEVEL OR CURRENT OMWPK COUNTY MARKET RATE, AN ADDITIONAL UP TO PROVIDER RATE. Provider overages may be charged to 10% RATE INCREASE WILL AUTOMATICALLY BE APPLIED TO PAYMENT AMOUNT – NOT TO EXCEED THE OMW family at the provider’s discretion. COUNTY MARKET RATE – DO NOT CALCULATE THIS INTO YOUR WEEKLY CHARGE. Attendance Parents receive a Hoosier Works swipe card – Parents receive a Hoosier Works swipe card – provider provider receives a Point of Service machine receives a Point of Service machine
I am willing to enroll (please check one or both):