Educator Enrollment Form 2020-2021 Question Title * 1. Name of educator (first and last) Question Title * 2. Site name (name of preschool) Question Title * 3. Address of site Question Title * 4. Best address for packages Question Title * 5. Site type Center/preschool Licensed home-based site Question Title * 6. Your classroom setting In person Virtual Question Title * 7. Quality First status Yes, my site/school is currently participating in Quality First No, my site/school is not enrolled in Quality First Question Title * 8. Email address Question Title * 9. Cell phone number Question Title * 10. Preferred method of contact Email Text Phone call Question Title * 11. How did you learn about enrollment in Make Way for Books? Question Title * 12. Language preference English Spanish Bilingual Other (please specify) Question Title * 13. Teacher type Infant teacher (less than a year) Toddler teacher (1-2 year olds) Preschool teacher (3-5 year olds) Question Title * 14. AZ Workforce Registry Number Question Title * 15. Date you started working in early childhood field (mm/dd/yyyy) Question Title * 16. Date you started working at current site (mm/dd/yyyy) Question Title * 17. Race/ethnicity African American Asian/Asian American /Pacific islander Caucasian / White Hispanic / Latino Native American / American Indian / Alaska native multiracial (multiple races) other (an ethnicity not listed) prefer not to answer Question Title * 18. What is the highest level of school you have completed? High school degree/GED CDA Currently enrolled in CDA program Associates degree Other post high school program Enrolled in college/university Completed degree Completed advanced degree Question Title * 19. Do you, the teacher, grant Make Way for Books permission to publish photographs and videos of you in print, social media, and/or video-based materials? Yes No Done
