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HRDC District 7
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How Can We Help?
I need help finding childcare
I need to find a place to stay
I want to gain an education
I need help finding a job
I want to learn how to buy a home
I need help paying my energy bill
I need help building my resume
Our Impact
Calendar
Get Involved
Donate
Volunteer
Contact
Child Care Needs Form
Click Submit at the end of this form.
In order to find the best match for you and your children’s needs, please complete the following information. The information provided is for referral purposes only. Montana Child Care Resource & Referral agencies and the Best Beginnings Child Care Referral Program do not guarantee the information concerning any provider, nor do we license, endorse, or recommend any particular provider. Only you can determine whether the quality of care is appropriate for your child by thorough screenings and visits with the provider prior to care being provided.
Contact Information
Have you ever received a referral listing in Montana?
*
Yes
No
Name
*
First
Last
Home Address (physical)
*
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
County
*
Big Horn
Carbon
Carter
Custer
Fallon
Golden Valley
Musselshell
Powder River
Rosebud
Stillwater
Sweet Grass
Treasure
Wheatland
Yellowstone
Mailing Address
Same as Home Address
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Primary Phone
*
Secondary Phone
Fax Phone
Email
*
Enter Email
Confirm Email
Tell us a little bit about yourself...
Do you live in an.....
*
Apartment
House
Mobile Home
*If other please specify, for example, hotel, motel, camp ground, shelter
What best describes you?
*
Employed
Seeking Employment
Student
At-home Parent
Serving in the Military
Child and Family Services Division
Foster Parent
Select only the primary one.
Do you currently receive the Best Beginnings Child Care Scholarship?
*
Yes
No
If yes, what program are you paticipating in?
*
Non-TANF
TANF
Tribal TANF
CPS
Unknown
Do you have a preference on a child care provider's location?
Indicate only one of the following.
Zip Code
City
Elementary School
County
Tell us a little bit about your children and the care requests you have
Providing this information helps us to better match you with child care providers.
Starting date that child care is needed
*
MM slash DD slash YYYY
Child Care Days and Hours Needed
Click in 'Add child' and fill out the the fields for each child requiring care. Missing information prohibits us from being able to provide you a list of child cares. If your hours and days are varied, please list all potential days and hours care may be needed. For example, list the earliest time you would ever work and the latest you would ever work.
What kind of child care provider would best meet your needs?
What kind of schedule should the provider be able to accommodate?*
Full-time (30+ hrs./week)
Part-time (less than 30 hrs./week)
Before School
After School
Rotating Schedule
Summer only
Check all that apply.
Do you speak any of the following languages?
English
Native American
Spanish
French
German
American Sign Language
Other
Multiple choices can be made.
What type of care are you looking for?
Child Care Center (13 or more children)
Group Child Care (7-12 children)
Family Child Care (3-6 children)
Preschool program
School age program
(CCC) Tribal Licensed Program
Head Start
Do you have any needs/preferences regarding the child care provider's environment?*
Provider will toilet train
Offers field trips
Wheelchair accessible
Uses a structured curriculum
Summer program
No pets at facility
Outdoor play equipment/activities
No TV
STARS to Quality Provider
Preschool Program
English as a Second Language
Check all that apply.
If you are looking for a child care provider with special needs experience, please specify.
Would you like your list to include providers that have waiting lists?
Yes
No
Transportation needs (if required)*
I need child care to be walking distance from school
I rely on public transportation
I require transportation to and from school
I need family transportation
What is your realtionship to the child(ren)?
Mother
Father
Grandparent
Guardian
Case Manager
Please select one. If other, please specify.
Just a couple more questions and you're done!
Answering these questions helps us to tailor our services to the needs of the community and better understand who is currently looking for child care.
How did you learn about child care referral services?
Employer
Friend or relative
Previous user
Media: Newspaper, radio, TV
Brochure/Rack Card
Community agency
Tribal program
Phone book/Yellow pages
Child care provider
Regional Child Care Resource and Referral Agency
Internet/Website
State of Montana Agency
Please check all that apply.
What is your reason for seeking child care?*
Work
Looking for work
School/training
Respite care
Child's needs
Parent's needs
Current care closing
Asked to change child care providers
Current environment did not meet child's needs.
Woulld you like a personal consultation on selecting quality child care?
Yes
No
If yes, please call and schedule an appointment time to speak with our referral specialist. (406) 247-4700
"Tips for Finding Quality Child Care" on our site provides fantastic information about selecting child care, child development, and more. Is there any more information you would like in addition to what is available on our website?
How would you like to recieve the consumer education information?
Mail
Email
I will pick it up
I do not want Consumer Education
I would like to have my child care referral list:
I will pick it up at HRDC
Mailed to me at the address listed on the form.
Faxed to the number listed on the form.
Emailed to me at the email address listed on the form.
Please select one. A child care referral will be available within 1-2 business days and will be provided to you in the preferred way indicated below.
This section is available for you to leave any additional information for the Referral Specialist.
CAPTCHA
Do you, a friend or a family member need assistance?
(406) 247-4732
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