Docusign Epvelope ID: 31BE179F-5256-404C-8BFA-8DE06AC88DD8 Alameda County
Social Services County of Alameda
Agency 2024 Licensed Provider Grants
*Required
1. Legal/Licensed Name of Your Child Care Program*
Emeryville Child Development Center
2. First Name* 3. Last Name*
Desiree Garland
4. Phone Number (10 Digits)* 5. Email*
510-596-4367 [email protected]
6. Child Care Program Site/Facility - ADDRESS*
1220 53rd St Emeryville CA 94608
7. Child Care Program Site/Facility - CITY* 8. Child Care Program Site/Facility - ZIP* Emeryville 94608
9. Are You a Licensed Child Care Provider?* x Yes No
10. Provider License Number* Preschool #010213812 Infant# 020213813
11. Is Your Child Care Program Currently Caring for Children?* × Yes No
12. Licensed Provider Type*
Small Family Child Care (Licensed capacity for 8 less children) Large Family Child Care (Licensed capacity for 12 or more children) x Center-based
13. How long has your child care program been in operation? (In Years)* 33
14. Is your program fully enrolled?*
Yes
x No, and we have current openings
No, and we are currently limiting enrollment to allow for social distancing
15. Do any children, in your current care, have special needs?* X Yes No
16. Are any children, in your current care, paid for by a subsidized payment program?* × Yes No
17. Are you in good standing with Community Care Licensing? If no, please list any violations.* X Yes No
Docusign Envelope ID: 31BE179F-5256-404C-8BFA-8DE06AC88DD8 Alameda County
Social Services County of Alameda
Agency 2024 Licensed Provider Grants
18. Preferred Language* English
19. Preferred/Permanent Mailing Address (where you will receive communcations)* 1220 53rd St Emeryville CA 94608
20. Preferred/Permanent Mailing - CITY* 21. Preferred/Permanent Mailing - ZIP* Emeryville 94608
22. Race/Ethnicity (check all that apply)
African American or Black Hispanic or Latino
American Indian or Alaskan Native Multi-ethnic
Asian Native Hawaiian or other Pacific Islander
Caucasian Other
Filipino Prefer not to say
23. Gender
Female
Desiree Garland
Name*
Signature* Date*