2021-22 PD Stipend Participation - Alternative Sites

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* 1. Your name:

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* 2. Which program do you work at?

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* 3. Your position:

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* 4. What is your 9 digit Registry ID number?

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* 5. Your email address (email is the primary method of communication for Quality Counts CA Nevada County):

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* 6. Your phone number:

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* 7. PD options you wish to participate in (check all that apply):

Option 1: College Coursework

Option 2: Professional Development training/workshops (ASQs)

Option 3: Instructional Coaching

Option 4A: For Licensed and Alternative Child Care Programs

Option 4B: Nurtured Heart Approach

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* 8. Your current highest education level:

High School Diploma or GED

Some college

AA

BA/BS

Graduate degree (MA/MS, PhD)

Other (please specify)

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* 9. Your current Child Development Permit level (enter N/A if you do not have one):