We've detected that Javascript is not enabled. It is required for an optimal survey taking experience.
Please check your browser's settings and make sure Javascript is turned on. Learn how to enable Javascript.

Skip survey header

CES Early Childhood Professional Development Request Form

1. What is your name (first and last)? *This question is required.

2. (Optional) What is the phonetic pronunciation of your name?

3. What are your preferred pronouns (Examples: She/Her, He/Him/, They/Them)

4. What is your email address? *This question is required. This question requires a valid email address.

5. What is your phone number? *This question is required.

6. Are you a CPPI Program? *This question is required.

7. What is your school district? *This question is required.

7. Which towns/cities do you serve? *This question is required.

7. Which CPPI Priority Areas have you selected? Check all that apply. *This question is required.

Expansion of access to affordable, high-quality preschool
Alignment of curriculum and supports across the mixed-delivery system
Equitable access to special education and inclusion

7. What is your program name? *This question is required.

7. What is the address of your program? *This question is required.

8. What services and supports are you seeking? Check all that apply. *This question is required.

Professional Development (PD) Topic Sessions
Coaching/Consulting
Program Evaluation
Strategic Planning
Professional Learning Community (PLC)
Parent/Caregiver Education Workshops
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

9. Are you interested in-person or virtual services? *This question is required.

10. How many participants are you expecting? *This question is required.

11. What ages do you work with? Check all that apply. *This question is required.

Infant
Toddler
Preschool/PK
Kindergarten

12. What is your timeline for these services? Are there preferred or specific dates for these services? *This question is required.

13. What specific topics are you interested in? *This question is required.

14. Please share some times you are available to meet with us to help us better understand your needs and interests *This question is required.

15. Is there anything else you would like to share about your program or your interests/needs? *This question is required.