Agency/Home Name:	Progressive Community Center
Contact Person:	Dorothy Gray
Address:	56 East 48th Street Chicago, IL 60615
Phone:	(773) 924-6561
Email Address:	dgray5648@sbcglobal.net

1. Model (Please check only one. Complete separate forms for different collaboration models.)

	One Agency, Multiple Funders A single program or agency blends/braids funds and program requirements from multiple sources at a single site.
	Multiple Agencies Partner Two or more agencies, which are separate legal entities, partner to serve children at a single site.
	Partnering with Family Child Care A program or agency partners with family child care home providers.

2. Collaboration Type (Check all that apply to this collaboration model.)

	Child Care/Early Head Start
	Child Care/Head Start
	Child Care/PreK
	Child Care/Head Start/PreK
	Head Start/PreK

3. Partnership Initiated By

	Child Care
	Head Start/Early Head Start
	PreK
	Other (specify): _________________________________________
	______________________________________________________

4. Demographics

	Urban
	Rural
	Suburban

5. Schedule

Hours per day:	11
From:	7 a.m.
To:	6 p.m.
Days/Weeks per year:	248 days per year, 5 days/week
Holidays or other time “off” or closed:	12 Holidays; 3 staff in-service
If this is an Early/Head Start collaboration, please indicate the program option & number of Early/Head start hours:	center based; part day HS with child care to extend

6. Number of Children Served Full-Day/Year by Location, Setting & Age
Setting includes: Head Start/Early Head Start site; Child care center; Family child care homes; Public/private school system; Other (explain/describe)

Location	Setting	# Infants	# Toddlers	# Preschool
56 East 48th Street, Chicago	Center based		13	29

7. Total number of children served by organization

	0-150
	151-500
	501-2000
	2001-6000
	6001+

8. Total number of children served by partner’s organization (if applicable). Note: this means an early care & education partner with whom you are collaborating. Agencies that checked “One Agency, Multiple Funders” in question 1, page 1 of this survey will NOT complete this question.

	0-50
	51-150
	151-300
	301+

9. Funding used to support full-day/year services (Check all that apply.)

	Federal Early/Head Start
	State Early Childhood Block Grant from IL State Board of Education
	State Early Childhood Block Grant from School District (including Chicago Public Schools)
	State Child Care Assistance Program through contract with IL Dept. of Human Services
	State Child Care Assistance Program through local Child Care Resource & Referral Agency certificate program
	Parent Fees
	Other (Specify): ____________

10. Administration/Management (Check either yes, no or not applicable – NA – for each item.)

a. Does the collaboration have a legal written agreement/contract?	No	Yes	NA
b. Other than a contract, does the collaboration have a written partnership plan?	No	Yes	NA
c. Are there written monitoring/oversight procedures?	No	Yes	NA
d. Are there written procedures for communication among partners?	No	Yes	NA
e. Is there a written cost allocation plan/budget for the collaboration?	No	Yes	NA
f. Is there a written training/professional development plan?	No	Yes	NA
g. Do job descriptions reflect staff' collaboration responsibilities?	No	Yes	NA
h. Is there a shared computerized MIS system? – HS & Child Care	No	Yes	NA
i. Do the partners share business operations & equipment costs?	No	Yes	NA
j. Do the partners purchase transportation jointly?	No	Yes	NA
k. Is there a competitive written RFP process for partner selection?	No	Yes	NA
l. Is there an ongoing advisory group for the collaboration?	No	Yes	NA
m. Did the partnership develop out of a broad based community planning process?	No	Yes	NA
n. Are parents involved in the collaboration planning & evaluation processes?	No	Yes	NA
o. Does the collaboration have a written evaluation process?	No	Yes	NA
p. Has the agency had any audit findings in the past 3 years?	No	Yes	NA
q. When was the agency's last federal monitoring review? 2005
Were there any problems identified? All findings cleared	No	Yes	NA
r. When was the agency's last licensing visit? January 2006
Were any problems identified?	No	Yes	NA
s. When was the agency's last DHS monitoring visit?_____________
Were any problems identified?	No	Yes	NA

11. Has the collaboration had an impact on the partner’s internal practices with regard to (check yes or no for each item):

a. Parent Decision Making	No	Yes
b. Parent Education	No	Yes
c. Parent Involvement	No	Yes
d. Family Support Services	No	Yes
e. Staff Salaries	No	Yes
f. Employee Benefits	No	Yes
g. Management Practices/Structure	No	Yes
h. Staff Training/Professional Development	No	Yes

12. Program Services (Make 2 checks for each item – 1 to indicate which partner is primarily responsible for direct service delivery and the other to indicate which children receive that service – all or just the collaboration children.)

Services Provided	Partner Responsible for Direct Service Delivery				Children Receiving Services
a. Child education services	E/HS	CC	PreK	Other	All	Collab
b. Family support services	E/HS	CC	PreK	Other	All	Collab
c. Health services	E/HS	CC	PreK	Other	All	Collab
d. Mental health services	E/HS	CC	PreK	Other	All	Collab
e. Parent education/involvement	E/HS	CC	PreK	Other	All	Collab
f. Transportation services – N.A.	E/HS	CC	PreK	Other	All	Collab
g. Nutrition services	E/HS	CC	PreK	Other	All	Collab
h. Transition services	E/HS	CC	PreK	Other	All	Collab
i. Disabilities services	E/HS	CC	PreK	Other	All	Collab
j. Parent home visits	E/HS	CC	PreK	Other	All	Collab
k. Sick child care – N.A.	E/HS	CC	PreK	Other	All	Collab
l. Parent conferences	E/HS	CC	PreK	Other	All	Collab
m. Non-traditional hours service – N.A.	E/HS	CC	PreK	Other	All	Collab

13. Primary objectives for beginning this collaboration (check all that apply)

	Enhance family health services
	Enhance the quality of children’s education services
	Expand services into new communities
	Extend service hours
	Improve & maximize staff training/professional development
	Link early care & education systems in the community
	Maximize funding and cost effectiveness
	Maximize use of facilities
	Offer increased service options
	Offer parents home visits
	Respond to parents’ changing needs
	Serve a wider age range of children
	Extend days of service
	Serve siblings in one program
	Provide more economically & culturally diverse programming
	Increase the number of children served
	Provide continuity of care
	Improve staff compensation packages

14. Collaboration Development & Management

a. When did the collaboration begin?	November 2002
b. Are regular written management reports required to support the collaboration? If yes, explain below.	No	Yes
c. Are there regular required meetings between collaboration partners? If yes, explain below.	No	Yes
d. Is there written documentation to support the content of meetings?	No	Yes
e. Does the program/collaboration have a written planning process that includes all partners?	No	Yes
f. Does the collaboration have a written decision making process?	No	Yes
g. Why did the collaboration begin? City of Chicago Head Start needed to fill additional slots for age & income eligible children.
h. How were partners selected?
i. When there is a disagreement or conflict, how is it resolved with partners?
j. When a decision has to be made about the collaboration, how is this done with partners?
k. Explain how often reports & meetings are done/held:

15. Program Components: Please answer the following questions about your collaboration program. Show in column 2 which partner is responsible for each program component. Check which children receive the program component in the last 2 columns - either all children in the classroom(s) or just the collaboration children.

		Responsible Partner	Children Receiving Services
a. Does the program use a standardized curriculum? If yes, which curriculum? Creative Curriculum	No Yes		All	Collab
b. Does the program do child screening? If yes, what instrument is used? ESI-R How often are screenings done? Annually	No Yes		All	Collab
c. Does the program do ongoing child assessment? If yes, what instrument is used? Head Start NRS How often is assessment done? Quarterly	No Yes		All	Collab
d. Does the program take field trips? If yes, how often? 3X/month	No Yes		All	Collab
e. Does the program have family support staff/case managers? If yes, what is their caseload? ______________________ How often do they make home visits? _______________ How frequent are family contacts? ________________	No Yes		All	Collab
f. BRIEFLY describe your collaboration program’s social service delivery, if you have one, for example explain your crisis intervention and/or referral process(es): Not addressed.

Answer the following questions IN AS FEW WORDS as possible, still giving a picture of how your collaboration works. Use bullet point lists whenever possible.

16. List/describe any other program components included in the collaboration that are not described in items 12 and 15 (pages 3-4).

17. Please describe how budgeting and cost sharing among funding sources is done. How do you decide how costs will be shared? What are the financial arrangements between partners?

Cost is shared by using a cost allocation plan based on square footage, time and percentage.

18. Please explain how your collaboration is staffed. Include classroom and support staff and tell how this is changed/different from your regular program. Who funds the staff’s salaries? Who supervises the staff and who employs them? What salaries and benefits are offered collaboration staff and is this different from other staff?

Staff has not changed.  3 classrooms; 2 Teachers per classroom.  Staff is paid by all funding sources.  The Director supervises the teaching staff.  All benefits are offered to all staff.

19. Please tell about your written agreement, if you have one. Include: what the agreement covers (section titles); term (what the time period is); if finances are part of the agreement and how these were figured; etc.

We have a shared space agreement with the church.  We contribute monthly to the use of the space.  We cannot afford to pay fair market value of the space.  The difference is donated as in-kind from the church.

20. Please describe the training system for your collaboration. Include what kind of training is done, how costs are shared among funding sources and/or partners, and how it has changed since the collaboration began.

Each funding source provides training & workshops.  All information is shared with all staff members.

21. Please give any other details about your collaboration that you believe are important, but not covered elsewhere.

Child care funds decrease.  Head Start funds increased.

22. If you could start your collaboration over again, knowing what you know now, what would you do differently?

Would have more funding sources.  Budget amounts would be more.

23. What advice do you have for agencies/homes starting new collaborations?

Copyright 2005 Collaboration Model Description. Template. HS State Collab Office.10.05