Document
Office of Child Care School-Age Child Care Institute Registration Questions
ICR 202606-0970-009 · OMB 0970-0617 · Object 169938500.
Document Viewer [docx]
Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Office of Child Care School-Age Child Care Institute Registration Questions |
| Author | Maria Hrabak |
| Last Modified By | Writer |
| File Modified | 2024-04-17 |
| File Created | 2026-06-17 |
| Conversion State | complete |
Extracted Text
OCC School-Age Child Care Institute: Registration Questions
Meeting Registration
All fields followed by * are required.
Please select your role at this event. * (drop down list)
• Federal Employee
• State CCDF Administrator
• Territory CCDF Administrator
• State CCDF Staff Member
• Territory CCDF Staff Member
• OCC National Center TA Staff
• 21st Century Community Learning Center State Coordinator
• State Afterschool Network Lead
• Invited Presenter or Guest
• Other
◦ Please specify ______________
Contact Information
First Name *
Last Name *
Title *
Division/Department*
Organization *
City *
State *
ZIP Code *
Phone Number *
Email *
Emergency Contact Name
Emergency Contact Phone Number
Emergency Contact Email
OCC Region * (drop down list)
• Region I (CT, MA, ME, NH, RI, VT)
• Region II (NJ, NY, PR, VI)
• Region III (DC, DE, MD, PA, VA, WV)
• Region IV (AL, FL, GA, KY, MS, NC, SC, TN)
• Region V (IL, IN, MI, MN, OH, WI)
• Region VI (AR, LA, OK, NM, TX)
• Region VII (IA, KS, MO, NE)
• Region VIII (CO, MT, ND, SD, UT, WY)
• Region IX (AS, AZ, CA, GU, HI, MP, NV)
• Region X (AK, ID, OR, WA)
• N/A
Do you require any special accommodations?
☐ Yes
Please Specify ______________
☐ No