Office of Child Care National Tribal Conference Registration Questions

Status: Original and derived artifacts are available for this document.

Download: docx | pdf | html

OCC National Tribal Conference: Registration Questions
All fields followed by * are required.
Please select your role at this event. * (drop down list)
    • Tribal CCDF Administrator
    • Tribal CCDF Lead Agency Staff
    • Tribal Fiscal Staff
    • Federal Employee
    • OCC National Center TA Staff (drop down list)
        ◦ Child Care Automated Reporting System (CARS)
        ◦ Child Care Meeting Management Center (CMC)
        ◦ Child Care State Capacity Building Center (SCBC)
        ◦ Data and Information Systems Consultation Center (DISCC)
        ◦ National Center on Afterschool and Summer Enrichment (NCASE)
        ◦ National Center on Early Childhood Quality Assurance (NCECQA)
        ◦ National Center on Subsidy Innovation and Accountability (NCSIA)
        ◦ Tribal Child Care Capacity Building Center (TCBC)
        ◦ Tribal Child Care Program Support Center (TPSC)
    • Invited Presenter or Guest
    • Other 
        ◦ Please specify ______________ 

Contact Information
    • First Name * 
    • Last Name *
    • Title/Position *
    • Organization or Tribe/Tribal Organization *
    • City *
    • State *
    • Zip Code*
    • Telephone Number *
    • Email Address *
    • OCC Region * (drop down list)
            ▪ Region 1 (CT, MA, ME, NH, RI, VT)
            ▪ Region 2 (NJ, NY, PR, VI) 
            ▪ Region 3 (DC, DE, MD, PA, VA, WV)
            ▪ Region 4 (AL, FL, GA, KY, MS, NC, SC, TN) 
            ▪ Region 5 (IL, IN, MI, MN, OH, WI)
            ▪ Region 6 (AR, LA, OK, NM, TX)
            ▪ Region 7 (IA, KS, MO, NE)
            ▪ Region 8 (CO, MT, ND, SD, UT, WY)
            ▪ Region 9 (AS, AZ, CA, GU, HI, MP, NV)
            ▪ Region 10 (AK, ID, OR, WA)
            ▪ N/A

Are you a Public Law 102-477 Grantee? 
☐ Yes
☐ No
☐ Unsure

Do you require any special accommodations? 
☐ Yes
Please specify ______________
☐ No

Emergency Contact Information
Emergency Contact Name:	
Emergency Contact Telephone Number: 
Emergency Contact Email Address: