Name: Address: City: State: Zip:

Business Telephone: Home Telephone (optional): E-mail: Fax: Website:

Please indicate which age groups your training covers: Infant   Toddler   Preschool   School Age

Please indicate which program type your training(s) pertain to: Family Child Care   Center-based child care   School Age programs

Please select your area(s) of expertise

Health & Safety Nutrition Disease prevention & Control Safety & injury prevention Special issues (ie: SIDS, allergies, health care policies, etc.): Other:

Child Development Brain Development Social/emotional development Cognitive development Physical development Theories of child development Understanding and managing behavior Other:

Learning Environment Environmental Design Adult/child interaction Materials and equipment Learning centers Diversity Other:

Assessment/Evaluation Observation/Recording Child Assessment Program assessment (ie: standards & guidelines, ECERs, etc.) Teacher assessment Other:

Administration Business management (ie: contracts, licensing, marketing, finances, etc.) Staff management (ie: communication, recruitment/retention, etc.) Other:

Professionalism Career planning Accreditation/credentials Public policy/advocacy Leadership skills Other:

Special Needs ADD/ADHD Autism/PDD Sensory integration Mental health issues Speech/language delays Physical disabilities Inclusion/adaptations Assessment (ie: red flags, IEP, etc.) Community resources and services Sign language Other:

Families/Children at Risk Abuse / Neglect Domestic violence Childhood trauma Substance abuse Other:

Technology Basic computer literacy Software applications Internet/web resources Computers in the child care environment Other:

Family / Community Involvement Communication/relationships Diversity Resources Other:

Curriculum Curriculum theories (ie: Montessori, Reggio Emilia, High/Scope) Curriculum planning Emergent language and literacy Emergent mathematics Science History and social science Physical / motor activities Visual/creative arts Music Routines/transitions Mixed ages Cooking Sensory experiences Dramatic play Developmentally Appropriate Practice (DAP) Other:

Are you a bilingual/multi-lingual trainer? Yes     No Please list languages:

Where are you willing to travel? Western MA Metrowest Central MA Boston area Southeastern MA Cape Cod & Islands Northeast/Merrimack Valley

Educational Background: DEGREE MAJOR MINOR Associates Bachelors Masters Ph.D. Other

Number of years experience as a trainer: