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

Question Title

* 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, age 1, English

Children's book, age 2, English

Children's book, age 3, English

Children's board book, age 1, Spanish

Children's book, age 2, Spanish

Children's book, 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 (100/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

Early Care/Educator Primer on Use of Act Early Resources, English

Early Care/Educator Tip Sheet: How to Talk with Parents About Developmental Concerns, English

"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 - Siouxland, Madison, Parkston, Vermillion 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:

Question Title

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

Yes

Question Title

* 8. Are there additional resources that SD Act Early might provide?

Thank you for your order!