The code block below illustrates how one might use # and // as comments in your logic and calculations.

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Required format:

NvcPxzowhMye9uUvFtEB6HeiyXtT5AspVSYITfffK8JFBmhvoy3IRy84qNJEJ5NntztLnG9JqQfhmJcVXFzD5U83RvDr8MJeL

Child Care Social Emotional Learning w/ Conscious Discipline Approach Interest Form

Thank you for your interest in Social Emotional Learning (SEL) with Conscious Discipline approach training. This interest form is for individuals who work in child care programs. Training will be held statewide through community events or larger childcare programs may choose to host trainings at their site.

Status

Completed trainining/private training scheduled

Not subsidy provider

Not eligible/not good fit

Contacted, need to follow up

Reached out more than once

Notes

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First Name

* must provide value

Last Name

* must provide value

I am interested in training for:

* must provide value

Myself

My center/program

Other

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If other, please provide additional detail:

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Participation preference:

* must provide value

Face-to-face

Virtual

Either face-to-face or virtual works for me

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How many people would you like to have trained?

* must provide value

I would like to host a training at my facility:

* must provide value

Yes

Possibly

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Do you have any professional development days already scheduled on your calendar when you would like to hold this training? If so, please list the date(s):

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Does your center/program accept child care subsidy?

* must provide value

Yes

I don't know

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My role in early childhood education:

* must provide value

Classroom teacher

Family child care owner and/or teacher

Center director

Program support (kitchen, driver, etc.)

Other

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Employer

* must provide value

Employer Street Address

* must provide value

City

* must provide value

State

* must provide value

Zip Code

* must provide value

County

* must provide value

Hub

Phone

* must provide value

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.