Order Confirmation
This form must be completed by the program administrator within five days of receiving CPP-purchased items, attending a CPP-funded professional development opportunity, or obtaining CDA credentials.
Program Name (as listed on State License):
*
License Number (as listed on JFS License):
*
Program Type:
*
Please Select
Type A
Type B
Center
Preschool
Administrator Name:
*
First Name
Last Name
Administrator Email:
*
example@example.com
Phone Number (best contact):
*
Please enter a valid phone number.
Coach Name
*
First Name
Last Name
Coach Email:
*
example@example.com
Which of the following are you submitting an order confirmation for?
CPP- Purchased Items
Professional Development
CDA
Please select the vendor your order was placed through:
Please Select
Amazon
Construction Play Things
Kaplan
Lakeshore
Redleaf Press
Staples
Teaching Strategies
The Adventurous Child
Walmart
Other
If "Other" was selected, please type the name of the vendor below:
Order PO Number (can be found on the original order confirmation email from the vendor):
Date the Order Was Placed:
-
Month
-
Day
Year
Date
Date the Order Was Received:
-
Month
-
Day
Year
Date
Order Total $:
Were all items received?
Yes
No
Missing Items
Title of Professional Development
Date of Professional Development Attendance
-
Month
-
Day
Year
Date
Please Provide Details Confirming the CPP CDA Purchase (when CDA was obtained/renewed, etc.):
Additional comments:
Submit
Should be Empty: