UNM Early Childhood Services Center (ECSC) Resource and Referral Annual Update

For early childhood program use only

If you have more than one program please fill this out for each location. If you would like to complete this over the phone or if you have any questions please call 1-800-691-9067.

Name of person filling this out(Required)

First Last

Phone(Required)

This information is helpful in case we have additional questions.

Name of Program and/or DBA (Doing Business As):(Required)

Name of Owner(Required)

First Last

Type of Care(Required)

(Required) Do you wish to be referred by UNM Early Childhood Services Center (ECSC) Resource and Referral?

EPICS ID (If no EPICS ID, put "0")(Required)

Ages Accepted

Physical Street Address(Required)

Street Address Address Line 2 City State ZIP Code

County(Required)

Major Cross Streets

Is your mailing address the same as your physical street address?(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Point of Contact

Name(Required)

First Last

Phone Number (For families to call):(Required)

Website and/or Facebook page (insert link):

Do you accept the following?(Required)

Full Time Care

Part Time Care

Before School Care

After School Care

Drop-in Care

Open Holidays (excluding major ones)

Temporary / Emergency Care

Year Schedule(Required)

Schedule Data

Monday Start Time

Monday End Time

Tuesday Start Time

Tuesday End Time

Wednesday Start Time

Wednesday End Time

Thursday Start Time

Thursday End Time

Friday Start Time

Friday End Time

Saturday Start Time

Saturday End Time

Sunday Start Time

Sunday End Time

Do you accept children with special needs and/or disabilities?(Required)

Languages(Required)

English

Spanish

Other

Other Languages:(Required)

Meals(Required)

Breakfast

AM Snack

Lunch

PM Snack

Dinner

Evening Snack

Parents must send all meals/snacks

Pets:(Required)

Transportation to and/or from Elementary Schools(Required)

Transportation Not Provided

Transportation Provided

School bus stop is close to provider

Walking Distance to School

Near Public Transportation

If selecting school transportation, please list schools:(Required)

Financial Assistance(Required)

Accepts Full Time Child Care Assistance

Accepts Part Time Child Care Assistance

Does not accept Child Care Assistance

Environment(Required)

Information

Quick Links and Useful Information

UNM Early Childhood Services Center (ECSC) Resource and Referral Annual Update

UNM Early Childhood Services Center (ECSC) Resource and Referral Annual Update

Information

Quick Links and Useful Information

NM ECECD

Early Childhood Education and Family Services Portal

Moments Together NM

Am I Eligible Application for Child Care Assistance

YES NM Portal Application for Services