REGISTER FOR THIS BUSINESS COURSE

REGISTRATION IS NOW OPEN FOR:

1. THOSE WISHING TO TAKE THE COURSE IN ENGLISH AND LIVE IN THE FOLLOWING COUNTIES: Marion,Polk,Yamhill,Jackson,Josephine

2. THOSE WHO SPEAK UKRAINIAN IN MULTNOMAH COUNTY AND SURROUNDING AREAS.

Those who complete the course will be eligible to receive up to $3500 in grant awards.

First Name

Last Name

Your Phone

Your Email

Your Street Address

Your Zipcode

Are you currently serving families and running a child care business? Are you currently serving families and running a child care business? Yes No

If so, how long? ("0" if not open yet)

Are you currently licensed? Are you currently licensed? Yes No

What type of license do you currently hold or plan to hold? What type of license do you currently hold or plan to hold? Registered Family Certified Family Child Care Center None/Other

If licensed, please enter your license number

Have you, and anyone else in your home over 18, completed a background check and are enrolled in the Central Background Registry? Have you, and anyone else in your home over 18, completed a background check and are enrolled in the Central Background Registry? Yes No In process

If no, please tell us more

Do you have a location for your child care program and approval to use that location for this business? Do you have a location for your child care program and approval to use that location for this business? Yes No

If no, please tell us more

What trainings have you taken to prepare for opening your child care business (check all that apply) What trainings have you taken to prepare for opening your child care business (check all that apply) Intro to Registered Family, Part 1 Registered Family Part 2 First Aid/CPR Child Abuse and Neglect Food Handlers Certification Safe Sleep Training Foundations of learning Not sure

What age group(s) of children do you care for (check all that apply) What age group(s) of children do you care for (check all that apply) Infants and Toddlers Preschool School-Age

Do you (or will you) provide 24 hour care, swing shift care, or care before or after 8am and 6 pm ? Do you (or will you) provide 24 hour care, swing shift care, or care before or after 8am and 6 pm ? Yes No

How comfortable are you with using a computer and the internet? How comfortable are you with using software programs like word and excel?

This business course will meet six times from 6-9pm. You will need access to transportation to attend the in-person sessions and access to a computer and internet to attend the zoom advising sessions. Will you need support to attend or fully participate? Will you face any challenges in being able to attend these sessions?

What language would you like to take this business course in? What language would you like to take this business course in? English Spanish Somali Ukrainian Russian

For in person classes, dinner will be provided. Do you have any food, allergies or dietary restrictions? Please list. "0" if no restrictions

What is your race/ ethnicity? What is your race/ ethnicity? African African American Asian Hispanic/Latinx Middle Eastern Native American/ Alaska Native Pacific Islander Slavic White Multi-racial/Bi racial Prefer not to answer