BSAC September 8, 2026 and September 10, 2026(In Person)-CEU

Thank you for registering for professional development with One Place. Please direct all training questions and concerns to Shannon Niro, Early Education Administrative Coordinator at shannon.niro@oneplaceonslow.org

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1. Name (Required.)

First Name

Last Name

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2. Email Address- this email address is where you will receive your link to access training and your training certificate. (Required.)

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3. Sign me up to receive email updates about One Place!! (Required.)

Yes, please!

No, thank you!

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4. Primary Telephone Number (Required.)

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5. Age (Required.)

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6. Gender (Required.)

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7. Race/Ethnicity (Required.)

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8. Are you military affiliated? (Active Duty, Veteran, or Dependent) (Required.)

Yes

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9. Employer/Child Care Facility Name (Choose N/A and type your center name in OTHER box if your center is not listed) (Required.)

Other (please specify)

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10. Child Care Facility Type (Required.)

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11. County of Employment (Please choose OTHER and type your county of employment if your county is not listed) (Required.)

Carteret

Green

Jones

Lenoir

Martin

Onslow

Pitt

Other (please specify)

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12. Early Educator Job Status (Required.)

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13. Age Group of Children you Serve
(check all that apply) (Required.)

0 - 36 months

3 years to 5 years old (not in Kindergarten)

School Age (Kindergarten and above)

N/A- I do not work in an early education classroom

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14. Number of Children you Served by Age Group (all sections must be filled- type a zero in the sections that do not pertain to you): (Required.)

0-36 months

3 years old to 5 years old (not in Kindergarten)

School Age (Kindergarten and above)

N/A- I do not work in a an early education classroom.*please enter zero

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15. I wish to register and submit payment for BSAC-CEU(In Person)-on September 15, 2026 and September 17, 2026-6:30 PM to 8:30 PM (Required.)

Yes- Pay Now - $25 USD

Yes- Apply Credit(Registration will not be complete until credit is verified.) - $0 USD

Yes- Invoice Me(Invoicing available for participants from the same program.) - $0 USD

Yes- I am an One Place employee - $0 USD

You’ll enter payment info after the survey.

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16. Special Instructions (Any allergies, hearing/sight barriers, language barriers, etc that the instructor should be aware of. All information will be kept confidential)

BSAC September 8, 2026 and September 10, 2026(In Person)-CEU

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* 1. Name (Required.)

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* 2. Email Address- this email address is where you will receive your link to access training and your training certificate. (Required.)

Question Title

* 3. Sign me up to receive email updates about One Place!! (Required.)

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* 4. Primary Telephone Number (Required.)

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* 5. Age (Required.)

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* 6. Gender (Required.)

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* 7. Race/Ethnicity (Required.)

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* 8. Are you military affiliated? (Active Duty, Veteran, or Dependent) (Required.)

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* 9. Employer/Child Care Facility Name (Choose N/A and type your center name in OTHER box if your center is not listed) (Required.)

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* 10. Child Care Facility Type (Required.)

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* 11. County of Employment (Please choose OTHER and type your county of employment if your county is not listed) (Required.)

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* 12. Early Educator Job Status (Required.)

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* 13. Age Group of Children you Serve(check all that apply) (Required.)

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* 14. Number of Children you Served by Age Group (all sections must be filled- type a zero in the sections that do not pertain to you): (Required.)

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* 15. I wish to register and submit payment for BSAC-CEU(In Person)-on September 15, 2026 and September 17, 2026-6:30 PM to 8:30 PM (Required.)

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* 16. Special Instructions (Any allergies, hearing/sight barriers, language barriers, etc that the instructor should be aware of. All information will be kept confidential)

1. Name (Required.)

2. Email Address- this email address is where you will receive your link to access training and your training certificate. (Required.)

3. Sign me up to receive email updates about One Place!! (Required.)

4. Primary Telephone Number (Required.)

5. Age (Required.)

6. Gender (Required.)

7. Race/Ethnicity (Required.)

8. Are you military affiliated? (Active Duty, Veteran, or Dependent) (Required.)

9. Employer/Child Care Facility Name (Choose N/A and type your center name in OTHER box if your center is not listed) (Required.)

10. Child Care Facility Type (Required.)

11. County of Employment (Please choose OTHER and type your county of employment if your county is not listed) (Required.)

12. Early Educator Job Status (Required.)

13. Age Group of Children you Serve
(check all that apply) (Required.)

14. Number of Children you Served by Age Group (all sections must be filled- type a zero in the sections that do not pertain to you): (Required.)

15. I wish to register and submit payment for BSAC-CEU(In Person)-on September 15, 2026 and September 17, 2026-6:30 PM to 8:30 PM (Required.)

16. Special Instructions (Any allergies, hearing/sight barriers, language barriers, etc that the instructor should be aware of. All information will be kept confidential)