Event Application

Section I: Applicant Information

HOME CONTACT INFORMATION

WORK CONTACT INFORMATION

Select Job Title* Center/Director/Administrator Center Teaching Staff Child Care Center/Preschool Director/Admin. College Center Director/Administrator College Center Teaching Staff Family Child Care Director/Owner Family Child Care Assistant HS/EHS Director/Supervisor HS/EHS Home Visitor HS/EHS Classroom Teacher HS/EHS Administrator HS/EHS Disability Specialist HS/EHS Specialist PITC PQ Trainer PITC Regional Coordinator Consultant/Trainer Teen Parent/ROP/High School Resource & Referral Agency College Instructors Early Start Funded Family Resource Center Family Leader Early Intervention/Special Education - Other
if other specify
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EVENT YOU WISH TO ATTEND

Select ONE Desired Event*
Beginning Together Institute | December 7 - 11, 2009
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APPLICATION QUESTIONS

1. What degrees, professional certification, or credentials do you currently hold?*

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2. What years did you attend the four PITC modules?*

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3. In what settings have you offered PITC/early childhood trainings?*

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4. Briefly describe the three most recent early childhood trainings you have conducted: (indicate if the training was specific to infant/toddler and the content, audience, format)*

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5. In what settings do you envision offering trainings which incorporate information on infants/toddlers with special needs? (Do you regularly train for PITC Partners for Quality?)*

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6. What are your hopes for this Institute?*
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7. Are there specific questions or issues in the area of special needs or disability you have encountered in training situations that you hope you will be able to address after this training?*
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8. What barriers to including infants and toddlers with disabilities in caregiving settings have come up during training and your other work with early childhood providers?*
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9. Have you ever co-trained on PITC content with a partner...with a partner with special needs background?*
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10. What else would you like to share about your interest in this Institute or future training ideas?*
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