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Program Self Evaluation ELCD 4000 Instructions


Instructions for completing the Fiscal Year (FY) 2019–20 Program Self Evaluation (PSE) form ELCD 4000

To ensure access to the Fiscal Year (FY) 2019–20 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) PSE form ELCD 4000 per contractor. The PSE form ELCD 4000 is to include all contract types.

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. 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. Complete the Program Review Instrument (PRI) by clicking on the link and completing the PRI for your contract type(s).
7. Signature of Program Director, as listed in the 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. Scan and email the signed PSE form ELCD 4000, all four (4) pages, including additional sheets, together to fy1920pse@cde.ca.gov using the fiscal year (FY) and the contractor’s legal name in the subject line (example: 19-20 XYZ School District).
NOTE: All supporting documents required as part of the PSE (see Statement of Completion) are to be kept on site and shall not be included with the submission of the PSE.

Instructions for Summary of the Program Self-Evaluation

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13. In accordance with the California Code of Regulations, Title 5 (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:

1. Who was involved
2. How were they involved

Use additional (Word document) sheets as necessary

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14. In accordance with the 5 CCR, Section 18279(b)(5), provide a summary of the program areas that:

A) Did not meet standards and
B) A list of tasks needed to improve those areas.

Summary is to include all contract types for your agency.

Answers are not limited to the space provided. Attach additional (Microsoft 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

15. In accordance with the 5 CCR, Section 18279(b)(5), provide a summary of the program areas that:

A) Met standards and
B) Explain the procedures for ongoing monitoring to ensure that those areas continue to meet standards.

Summary is to include all contract types for your agency.

Answers are not limited to the space provided. Attach additional (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 Instructions

1. Check that all sections, on all four (4) pages, have been completed.

2. All pages, including additional sheets, must be submitted together as one (1) document.

3. Only one (1) PSE form ELCD 4000 per contractor.

NOTE: All supporting documents required as part of the PSE are to be kept on site and shall not be included with the submission of the PSE.

4. Scan and email the signed PSE, all four (4) pages, including additional sheets, together to fy1920pse@cde.ca.gov using the FY and the contractor’s legal name in the subject line (example: 19-20 XYZ School District).

Questions:   Early Learning and Care Division | 916-322-6233
Last Reviewed: Friday, February 28, 2020
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