CCP Workshop Application CCP Workshop Registration Form Applicant InformationSponsor of Workshop* Name of Person Completing This Application* First Last Your Title* PhoneEmail* Workshop InformationDate of Workshop* MM slash DD slash YYYY Title of Workshop* Length of Workshop (Hours)* Name of Instructor(s) Educational Qualification of Instructor(s)*Resume of Instructor (Optional) Your browser doesn't have Flash, Silverlight or HTML5 support. Experience Qualification of Instructor(s)*Supporting Documents for Experience (Optional) Your browser doesn't have Flash, Silverlight or HTML5 support. Applicable CCP Area Ability/Abilities. The ability to:*establish and maintain a safe, nurturing, and purposeful learning environment.promote children's physical, cognitive, social, and emotional development.create a purposeful learning environment through curriculum and content.create an inclusive and culturally responsive learning environment.engage in effective management of learning environments.maintain a commitment to professional development and leadership.use assessment planning of learning opportunities and documentation of outcomes.demonstrate knowledge of child development theory, research, and practice.demonstrate computer literacy and promote learning through technology.Outline of Workshop*Workshop Outline Upload (Optional) Your browser doesn't have Flash, Silverlight or HTML5 support. How is Your Organization Properly Scheduling Clients to Maximize Enrollment?*Will there be any evaluation of the students?* Yes No If You Answered 'Yes'; Please Describe the Evaluations*What is the Value of the Workshop?*College CreditGraduate CreditCEU'sClock HoursIf you answered 'Clock Hours' to the question above, how many? Is the workshop approved for your state’s training requirements through your licensing agency? Yes No Certification By submitting this application, you certify that this information is accurate to the best of your knowledge. Δ
