2022-23 PD Stipend Participant Application for TK/K Teachers

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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:

Director

TK Teacher

K Teacher

After School Teacher at a School Site

Other (please specify)

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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 Super Saturdays

Option 3A: Professional Learning Community Culturally Responsive

Option 3B: Professional Learning Community Eliminate Implicit Bias

Option 4A: Site-Based/Onsite/In-Person Instructional Coaching

Option 4B: Online Instructional Coaching

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* 8. If you selected option 1, which classes are you hoping to attend this year? This information will help us work to ensure that the classes are made available.

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* 9. Your current highest education level:

High School Diploma or GED

Some college

BA/BS

Graduate degree (MA/MS, PhD)

Other (please specify)

2022-23 PD Stipend Participant Application for TK/K Teachers

Question Title

* 1. Your name:

Question Title

* 2. Which program do you work at?

Question Title

* 3. Your position:

Question Title

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

Question Title

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

Question Title

* 6. Your phone number:

Question Title

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

Question Title

* 8. If you selected option 1, which classes are you hoping to attend this year? This information will help us work to ensure that the classes are made available.

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* 9. Your current highest education level:

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