FCCN By Request Training Intake Form | Western Kentucky University

If you see this don't fill out this input box.

Thank you for expressing interest in scheduling training with one of our ECE-TRIS Approved Trainers. Please complete this intake form as accurately as possible. If you are requesting multiple trainings to be completed, please indicate that within the Training Topics Request. Based on your responses, one of our trainers will be in touch shortly to discuss training topic(s), date(s), and time(s).

* First and Last Name

Program Name (If Applicable)

* Email Address

* County

* How many hours of training are you interested in?

* Preference on Day of the Week

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Select all that apply.

* Which Training Method do you prefer?

In-Person

Virtual (Zoom)

Either In-Person or Virtual are acceptable

* If the training is In-Person, do you have space to host the training?

Yes

* How many individuals will be participating in this training?

If you are unsure about the number, a rough estimate will work.

* Are you willing to allow other Child Care Providers to register and participate in this training?

Yes

* What Age Groups Do You Care For?

Infants

Toddlers

Preschool

School-age

* What topic of training are you interested in receiving?

Early Care Education New Employee Orientation

Pediatric Abusive Head Trauma

Strengthening Business Practices

Developmental Screening and Assessment

Family and Community Engagement

KY Early Learning Standards

Other

Select all that apply.

If you chose "Other" for Training Topic, please list here.

By completing this form, you are acknowledging that you will work with a Trainer on creating an individualized training, and/or training plan, for your program and there will be a payment contract drafted upon confirmation of training details.