Skip to main content
California Department of Education Logo

Instructions for PSE Form ELCD 4000

Instructions for Early Learning and Card Division (ELCD) form ELCD 4000 for the annual Program Self-Evaluation (PSE) process.

Instructions for Completing the Fiscal Year 2018–19 Program Self-Evaluation (PSE)

Form ELCD 4000

Form ELCD 4000 Fiscal Year (FY) 2018–19 (PDF)

To ensure access to the Fiscal Year (FY) 2018–19 Program Self Evaluation (PSE) form ELCD 4000, it is recommended to download the latest version of Adobe Reader External link opens in new window or tab..

Contractors are to submit only one (1) form ELCD 4000 per contractor. All contract types for your agency are to be addressed in the form.

Page 1 of 4

Enter the following information.

  1. Contractor Legal Name. Full spelling of legal name only. Acronyms and/or site names will not be accepted.
  2. Four-digit vendor number (Example: 1234)
  3. Program Director name as listed in the Child Development Management Information System (CDMIS). (Check CDMIS for the most current information)
    NOTE: The CDMIS help phone number is 916-445-1907 and the email is CDMIS@cde.ca.gov.
  4. Program Director telephone number
  5. Program Director email address
  6. Read the Statement of Completion. (Check the boxes under Program Review Instrument that apply to your contract type[s])
  7. Signature of Program Director, as listed in CDMIS  (Wet Signature)
  8. Date of signature
  9. Name and title of contact person completing the PSE
  10. Contact person telephone number
  11. Contact person email address
  12.  NOTE: Submission instructions are located in the “Submission Instructions Section” (see page 3)

Instructions for Summary of the Program Self-Evaluation

Page 2 of 4

  1. In accordance with Title 5 California Code of Regulations (5 CCR), Section 18279(b)(3), provide an assessment, in a narrative format, summarizing the:
    A) Staff and
    B) Board member participation in the PSE process
    For example describe:
    Who was involved
    How were they involved
    Answers are not limited to the space provided. Use additional (Microsoft [MS] Word document) sheets as necessary.

Page 3 of 4

  1. In accordance with 5 CCR, Section 18279(b)(5), provide a summary of the program that:
    A) Did not meet standards and
    B) A list of tasks needed to improve those areas and addressed in a timely and effective manner.
    Summary is to include all contract types for your agency.
    Answers are not limited to the space provided. Attach additional (MS Word document) sheets as necessary.
    Note: All contractors are required to modify their programs to address all areas identified as needing improvement during the self-evaluation. Written tasks needed to modify the program would be specific or unique to the contract type and age group.

Page 4 of 4

  1. In accordance with 5 CCR, Section 18279(b)(6), provide a summary of the program that:
    A) Met standards and
    B) Explains the procedures for ongoing monitoring to ensure that those areas continue to meet standards and are addressed in a timely and effective manner.
    Summary is to include all contract types for your agency.
    Answers are not limited to the space provided. Attach additional (MS Word document sheets as necessary.
    NOTE: All contractors are required to identify areas that are satisfactory and provide procedures for ongoing monitoring of the program for assuring that those areas continue to meet standards.

Submission Requirements

  • Check that all sections, on all four (4) pages, have been completed.
  • All pages, including additional sheets, must be submitted together as one (1) document.
  • Only one (1) form ELCD 4000 per contractor.
    • NOTE: All supporting documents required as part of the PSE process are to be kept on site and are not included with the submission of the form ELCD 4000.
  • Scan and submit the signed form ELCD 4000, all four (4) pages, including additional sheets, together to PSEFY1819@cde.ca.gov using the current FY and the contractor’s legal name in the subject line (example: 18–19 XYZ School District).

Return to PSE Main Page


Questions:   Early Learning and Care Division | 916-322-6233
Last Reviewed: Friday, March 15, 2019
Recently Posted in Child Development