The Northeast Early Childhood Council received a grant from the Parent Trust Fund & its partners to hold this training.

To help us get to know you better, please take a few moments to complete the form below. We will contact you to confirm your sign-up, review the training commitment, answer any questions you may have and confirm your participation.

If there is any difficulty in completing this form, or if you have questions, please contact PEP Co-facilitators, Christine Rosati Randall @ 860-717-2009 or Kristine Cicchetti @ 860-431-0830.

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* 1. Please enter your contact information.

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* 2. Why are you interested in participating in the UCONN People Empowering People (PEP) Training?

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* 3. Please list any hobbies you may have, if any.

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* 4. Please list your experiences interacting with others in our communities, if any.

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* 5. Please describe your involvement with any community organizations or committees, if any.

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* 6. Please describe your public speaking or teaching experiences, if any.

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* 7. Do you have any special interests that this training may help you with?

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* 8. What are the ages of your child(ren) or grandchild(ren)?

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* 9. FREE on-site childcare is provided for participant's children, ages 2 & up.  If you would like to sign-up your child for the childcare, please put include their age(s) and first name(s) below.

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* 10. Is there anything else you want us to know about you or your family?

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* 11. How did you hear about this training? 

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* 12. FREE Dinner will be provided for participants and their accompanying children.  Do you or your child(ren) have any food allergies or dietary restrictions?  Please be specific.

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* 13. Is there anything that might prevent you from participating in, or completing this 10 week training?

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