Combined Story Project Educator Enrollment Form

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* 1. Your name (first and last)

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* 2. Site name (name of preschool)

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* 3. Address of site

Address

City

ZIP Code

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* 4. Best address for packages

Address

City

ZIP Code

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* 5. Quality First Status

Yes, my site/school is currently participating in Quality First

No, my site/school is not enrolled in Quality First

I am not sure of my site's Quality First status

Name of Quality First Coach

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* 6. Your email address

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* 7. Cell phone number

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* 8. Preferred method of contact

Text

Phone call

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* 9. How did you learn about enrollment in Make Way for Books?

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* 10. Language preference

English

Spanish

Bilingual

Other (please specify)

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* 11. AZ Workforce Registry status

Yes, I have my number

I need help obtaining a number

N/A-kindergarten teacher

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* 12. AZ Workforce Registry Number (used to receive Registry credit for attending MWFB professional development)

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* 13. Date you started working in early childhood field (mm/dd/yyyy)

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* 14. Date you started working at current site (mm/dd/yyyy)

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* 15. 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

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* 16. What is the highest level of school you have completed?

High school degree/GED

CDA

Currently enrolled in CDA program

Associates degree

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* 17. Number of children in your care

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* 18. Site type

Center/preschool

Licensed home-based site