EQIT Registration | Early Childhood Council of Larimer County

Which EQIT session are you registering for?

Fall 2019
Spring 2020

Name*

Phone*

Email*

Address

Current Place of Employment

If not employed, enter "none"

Employer Address

Street Address

Current Job Role

Please Answer the Following:

Are you currently working directly with infants and/or toddlers (under age 36 months)?

Yes
No

If yes, how many?

If not, what age group do you work with?

Why are you interested in taking this class? Check all that apply*

For ECT requirements
For Director requirements
For family child care license requirements (3 under 2, experienced, I/T)
For personal growth and knowledge

Coaching is available to compliment this training & can range from 2-8 hours per semester. Are you interested in receiving coaching through this training?*

Yes
No
Maybe

Commitment and Agreement

I agree to attend, participate in, and complete all 16 modules (13 class dates; 48 hours total) of the Expanding Quality in Infant Toddler Care course. If I miss more than two (2) modules, I understand that I will not be eligible to receive the EQIT completion certificate from the State of Colorado. I will complete make-up work that is assigned to me by the instructors for any missed class. I also allow pictures to be taken by ECCLC staff or instructors during my classes, to be used by the ECCLC for reports and marketing.

By digitally signing your name, you agree to the above statement.*

Product Name

For Non-College Credit

$50.00

For College Credit

$0, I will pay FRCC directly

Total

$0.00

Payment Method (Select one from the drop down menu)

Payment is due 1 week prior to the start of class to secure your spot! Priority of enrollment is given based on paid registrations as this course often has a waitlist. Cash or checks (made payable to ECCLC) should be mailed to: ECCLC, 2850 McClelland Dr, Suite 3400, Fort Collins, CO 80525.

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