Facility Name:

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* 1. Facility Name:

County:

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* 2. County:

Ages of children you work with (check all that apply):

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* 3. Ages of children you work with (check all that apply):

Which professional development topics for Infants and Toddlers would you be likely to attend?
(Please Check all that apply)

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* 4. Which professional development topics for Infants and Toddlers would you be likely to attend?
(Please Check all that apply)

Which professional development topics for Preschool age children would you be likely to attend?
(Please check all that apply)

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* 5. Which professional development topics for Preschool age children would you be likely to attend?
(Please check all that apply)

Which professional development topics for School Age would you be likely to attend?
(Please check all that apply)

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* 6. Which professional development topics for School Age would you be likely to attend?
(Please check all that apply)

Which professional development topics for working with children with Special Needs would you be likely to attend? (Please check all that apply)

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* 7. Which professional development topics for working with children with Special Needs would you be likely to attend? (Please check all that apply)

Which professional development topics for Program Management would you be likely to attend?
(Please check all that apply)

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* 8. Which professional development topics for Program Management would you be likely to attend?
(Please check all that apply)

Please list any additional professional development topics you would be likely to attend.

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* 9. Please list any additional professional development topics you would be likely to attend.

The best days and times for face to face training that work for me include: (Please check you top one or two days and times of interest)

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* 10. The best days and times for face to face training that work for me include: (Please check you top one or two days and times of interest)

  AM Lunch Afternoon After 6 pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Flexible/No Preference
Would you be likely to attend webinars if offered?

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* 11. Would you be likely to attend webinars if offered?

The best days and times for webinars that work for me include:

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* 12. The best days and times for webinars that work for me include:

  AM Lunch Afternoon/Naptime After 6pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Flexible/No Preference
Owner/Director Survey

Please answer the following questions only if you are an
Owner or Director
Are you or your staff interested in attending Professional Development opportunities in your area?

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* 13. Are you or your staff interested in attending Professional Development opportunities in your area?

Approximately how many staff members would be interested in attending Professional Development Opportunities?

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* 14. Approximately how many staff members would be interested in attending Professional Development Opportunities?

Would your facility be interested in hosting Professional Development opportunities?

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* 15. Would your facility be interested in hosting Professional Development opportunities?

Do you have adult table and chairs?

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* 16. Do you have adult table and chairs?

How many adults could you comfortably accommodate with the use of tables and chairs?

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* 17. How many adults could you comfortably accommodate with the use of tables and chairs?

Do you have a white screen or a blank light colored wall to project a PowerPoint presentation?

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* 18. Do you have a white screen or a blank light colored wall to project a PowerPoint presentation?

Who should we contact to discuss scheduling a training at your site?

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* 19. Who should we contact to discuss scheduling a training at your site?

Phone number:

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* 20. Phone number:

T