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SD Act Early Materials / SD Early Childhood Partner Materials Order Form
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
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
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
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
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 State Library - First Library Card (Rack Card) with Reading Milestones to 48 mos., Spanish
SD Toy Lending Library - Bookmarks, dual English/Spanish - ONLY Beresford, Madison, Parkston, Siouxland, Vermillion and Yankton Libraries
*
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.
(Required.)
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:
7.
Please indicate if you are a CHW/CHR...
Yes
No
8.
How did you learn of the Act Early materials?
Center for Prevention of Child Abuse (CPCM) / Early Childhood Comprehensive Systems (ECCS) Outreach
SD Act Early Ambassador
Other (please specify)
9.
Are there additional resources / languages that SD Act Early might provide to help you in your work?
10.
We invite you to share how these materials help you in your work and/or benefit children and families.
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.
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