Request to Update County Profile Contact Information

Please use this form to request updates to County Profile Contact information that appears on the Quality Counts California website. After submitting this form, a member of the Quality Counts California website team will be in contact with you to confirm your request.

Confirmation

This form is for QCC Lead Agencies only.

Please note that this form is to request updates to contact information only. To request updates to program information such as primary overview, funding streams and testimonials, please contact: [email protected].

Please make separate submissions for each program profile you wish to add or update.

I am authorized to make changes to this profile

Submitter and Consortium Information

First Name(Required)

Last Name(Required)

Agency(Required)

Email address(Required)

Consortium Name

Must match an existing Consortium. To confirm your consortium's name, visit County Program Profile and Services

Updates Required

Program Information

R&R Information

Program Information Updates

Any updates submitted here will replace the existing information on the website.

Please identify the type of program update your are requesting

Please identify the program that should be replaced

New Program Contact Information

Program Name

Primary?

If you have multiple lead agency contacts, please indicate if this is the primary contact.

Primary Contact

New Program Website

New Contact Name

New Contact Phone

New Contact Email

Child Care Resource and Referral Agency Updates

New R&R Agency Name

New R&R Agency Website URL

Is this a replacement or an addition to the existing R&Rs?

Please identify which R&R should be replaced.

File Uploads

Please upload logo files as jpeg or png files in the space below.

Logo Files

Drop files here or

Accepted file types: jpg, jpeg, png, Max. file size: 50 MB.

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