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* 1. Parent Email:

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* 2. Name of Parent:

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* 3. Parent Contact Number:

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* 4. Name of Child/Children:

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* 5. Child Care Center Child Attends:

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* 6. True or False:  There are five food groups in My Plate?

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* 7. As children move from infant to toddler to preschool, eating behaviors may change. Parents/caregivers must respond to these changes. There are four changes, choose two from the list below.

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* 8. Fill in the blanks.  Eating helps kids learn __________________ and _____________________.
Select your choice from the list below.

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* 9. Children benefit from sensory experiences and learn from self-feeding with  finger foods.  Choose three sensory developments below that were mentioned in this training.

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* 10. Did this training improve or add to your parenting skills? If so, how?

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* 11. What's one thing you will do differently because of the training you have completed.

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* 12. What parenting topics would you be interested in learning more about?

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* 13. Which race best describes you? (Please choose only one.)

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* 14. We love to hear success stories! Please provide a brief description of how the SSDC Child Care Scholarship Program has helped your family

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* 15. Would you be interested in speaking at our Annual Meeting in May and share how this program has made a difference in your life?

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