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ASQ:3 and ASQ:SE-2 Screening Training

ASQ:3 and ASQ:SE -2 Introductory Training Wednesday, June 10, 12:00-3:00pm, Registration

Please complete the registration information below. You will also receive paper copies of the training resources by U.S.mail before the training. A zoom link will be emailed to you closer to the training date.

1. First Name *This question is required.

2. Last Name *This question is required.

3. School District name, Charter, County (Public Health if you provide screening for districts) *This question is required.

4. Your email address *This question is required.

5. Re-enter Your email address to assure accuracy *This question is required.

6. Your phone number. *This question is required.

7. How long have you been an ECS Coordinator or Screener? *This question is required.

0-2 years
3-5 years
5 or more years

8. Please check your title- check all that apply. *This question is required.

Early Childhood Screening Coordinator
Early Childhood Screener
Early Childhood Family Education Coordinator
Early Learning Coordinator
County Public Health Nurse
Head Start Screener or Screening Coordinator
School Nurse, RN
Prekindergarten Teacher
Special Education Staff Please enter an 'other' value for this selection.
Volunteer
Other Please enter an 'other' value for this selection.

9. Please enter your address where we may send ASQ:SE-2 training materials. You may choose to have them sent to your home or your district address.

Include P.O. Box (if applicable), street, city, and zip code *This question is required.