* 1. Facility Name:

* 2. County:

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

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

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

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

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

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

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

* 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

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

* 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

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

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

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

* 16. Do you have adult table and chairs?

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

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

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

* 20. Phone number:

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