Document
DISCC UTA Registration Survey
ICR 202606-0970-009 · OMB 0970-0617 · Object 169939300.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | DISCC UTA Registration Survey |
| Author | Qualtrics |
| Last Modified By | Writer |
| File Modified | 2024-06-25 |
| File Created | 2026-06-17 |
| Conversion State | complete |
Extracted Text
Start of Block: Default Question Block
Please provide the following information to register:
• * First Name __________________________________________________
• * Last Name __________________________________________________
• * Email Address __________________________________________________
• * Job Title __________________________________________________
• * Type of Organization You Represent (select one)
◦ State CCDF Lead Agency
◦ Territory CCDF Lead Agency
◦ Tribal CCDF Lead Agency
◦ CCTAN Center
◦ OCC
◦ Other
• * Organization __________________________________________________
• * State/Territory in which your organization is located __________________________________________________
• Do you require any specific accommodations? __________________________________________________
• What questions do you hope will be answered during this webinar? __________________________________________________
End of Block: Default Question Block