Online Screening Web Site Name * Phone # * Which community do you live in? * What type of home do you live in? * Single house Duplex Apartment Townhouse Who lives in your home? # of adults # of children 12-18 years # of children 6-12 years # of children 0-6 years Do you have any early childhood experience/certification? * Yes No Why do you want to open an approved family day home? * What motivates you to work with children?