SD Act Early Materials / SD Early Childhood Partner Materials Order Form

Question Title

* 1. Please indicate the number of English Developmental Checklists with Tips/Activities you wish to order:

2 months

4 months

6 months

9 months

12 months

15 months

18 months

24 months/2 years

30 months

36 months/3 years

4 years

5 years

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* 2. Please indicate the number of Spanish Developmental Checklists with Tips/Activities you wish to order:

2 months

4 months

6 months

9 months

12 months

15 months

18 months

24 months/2 years

30 months

36 months/3 years

4 years

5 years

Question Title

* 3. Please indicate the number of books you wish to order...

Milestone Moments Booklet, English (includes all milestones 2 months - 5 years plus tips/activities

Milestone Moments Booklet, Spanish (includes all milestones 2 months - 5 years plus tips/activities

Children's board book Baby's Busy Day, age 1, English

Children's book Where Is Bear, age 2, English

Children's book Amazing Me, age 3, English

Children's board book Baby's Busy Day, age 1, Spanish

Children's book Where Is Bear, age 2, Spanish

Children's book Amazing Me, age 3, Spanish

Question Title

* 4. Please indicate the additional Act Early resources you would like to order...

Milestone Tracker app flier / dual English and Spanish (50/pack, order number packs)

Parent Tip Sheet: How to Get Help If You Are Concerned About Your Child's Development, English

Parent Tip Sheet: How to Get Help If You Are Concerned About Your Child's Development, Spanish

Professional Primer: Early Care Providers/ Educators & Use of Act Early Resources, English

Professional Tip Sheet: How to Talk with Parents About Developmental Concerns, English

Professional Training: "Watch Me" Flyer, CDC's Online Training (CEUs) for Early Care Providers and Educators, Dual English/Spanish

Question Title

* 5. Please indicate the partner materials you would like to order...

SD Parent Connection - Rack Card, English

SD Parent Connection - Rack Card, Spanish

SD State Library - First Library Card (Rack Card) with Reading Milestones to 48 mos., English

SD Toy Lending Library - Bookmarks, dual English/Spanish - ONLY Beresford, Madison, Parkston, Siouxland, Vermillion and Yankton Libraries

Question Title

* 6. Delivery Site Information: Please provide an address that a package may be left unattended if your office has limited operating hours during the week.

Name:

Email Address:

Organization, if applicable:

Street Address (cannot deliver to PO Box):

City:

Zip Code:

Phone:

Brief description of how you will use these materials:

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* 7. Please indicate if you are a CHW/CHR...

Yes

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* 8. How did you learn of the Act Early materials?

Center for Prevention of Child Abuse (CPCM) / Early Childhood Comprehensive Systems (ECCS) Mailing

Other (please specify)

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* 9. Are there additional resources that SD Act Early might provide to help you in your work?

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* 10. We invite you to share how these materials help you in your work and/or benefit children and families.

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* 11. Your help is needed to sustain our supply of SD Act Early materials and cover shipping expenses. If your organization can contribute to our Sustainability Fund, please let us know. Thanks for supporting SD Act Early!

Yes, I would like to support SD Act Early. Please contact me.