* 1. Name (First Last)

* 2. What is your affiliation/organization (e.g., a university, an afterschool program, a network, a state, etc.)?

* 3. Phone Number (where we can reach you during business hours)

* 4. E-mail Address

* 5. Please select the recertification training you are registering for:

* 6. Approximately, when was the last time you used DoS in the field?

* 7. Approximately how many DoS observations have you completed since you were first certified? 

* 8. For recertification, you must be comfortable using Adobe Connect to interact LIVE during trainings and to watch some recorded segments. Also, you must be comfortable using online websites like youtube or vimeo to watch video-clips. You must have access to high-speed internet, a phone line, and speakers. Are you comfortable with these technology requirements?

Thank you for your interest in DoS Recertification. A DoS Team member will contact you soon with more information.

* 9. How is your participation in DoS training funded?