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* 1. Name (First Last)

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

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* 3. What is the name of your affiliation/organization (e.g., university, afterschool program, network, state, etc.)?

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* 4. What state are you located in?

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

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* 6. E-mail Address

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

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

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* 9. For recertification, you must be comfortable using webinar platforms 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 and computer 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.

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* 10. How will your DoS Re-certification training be paid for?

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* 11. If you selected Option 3 for Question 10, please share the name of the state network or funding initiative.

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