CDA Renewal Scholarship 2021-2022 Question Title * Contact Information First Name Last Name Personal Email Address Personal Phone number CDA Council ID Number *This 7-digit number is found in your online account with the CDA Council. It is not your certificate number. Question Title * Child Care Program Information Name of Employer: Child Care Program Employer Address Employer Zip Code Employer: Child Care Program License number Question Title * What type of CDA will you pursue? Infant/Toddler Preschool Family Childcare Center Question Title * Please upload a copy of your current CDA certificate Only PDF, DOC, DOCX, PNG, JPG, JPEG, or GIF files can uploaded. DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File Only PDF, DOC, DOCX, PNG, JPG, JPEG, or GIF files can uploaded. Question Title * Policies and Statements: We attest that the applicant lives or works in one of the following 13 counties: Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Walker, Waller, and Wharton We attest that the applicant is a current employee at the center listed on the application. The candidate agrees to give permission to the Council for Professional Recognition to release their CDA renewal status and results to Collaborative for Children. We understand that maximum value of the scholarship is $125 for online submission ONLY. If submitted through mail, we are responsible for the additional processing fee. We attest that the applicant has completed all CDA Renewal requirements and is ready to be assessed. We understand that this application is not transferable to another person. We understand that if the applicant is not successful in attaining the CDA renewal or fails to complete the requirements by the deadline set by the CDA Council, another renewal scholarship may not be awarded. We understand that if the applicant does not redeem the scholarship by the due date attached to the voucher, the applicant must submit another application and commitment fee to receive another scholarship award. Upon receiving your official renewed CDA Credential in the mail, you agree to send a copy of it to Tamira.Campbell@wrksolutions.com Question Title * I acknowledge that I have read, understand, and will abide by the above named policies,procedures, statements, and instructions. By selecting yes, I am electronically signing this document. Yes Submit