IM-07 Attachment C - Head Start National Reporting System Training-of-Trainers Registration Form

Attachment C - Head Start National Reporting System Training-of-Trainers Registration Form

Printable form versions: (WORD) Download Word Viewer (PDF/116KB)

Registration is now open for the Head Start National Reporting System (NRS) Summer 2003 Training-of-Trainers. Please visit www.esilsg.org/NRStraining to register online and to view hotel and logistics information. The registration page will provide detailed instructions for completing the online registration process. Please email HeadStartNRS@esilsg.org for any registration questions not answered on the Website.

Based on the training design and capacity of the training teams for the Training-of-Trainers, each grantee and delegate agency with up to 400 children age 4 or 5 is requested to send one participant to the Training-of-Trainers. Programs with more than 400 children age 4 or 5 are requested to send an additional participant for each additional 400 children, ages 4 and 5.

A very limited number of additional Training-of-Trainers TOT slots are available to enable programs serving fewer than 400 children ages 4 or 5 to send two participants when necessary, in order to be able to provide local staff training on both the English and Spanish language versions of the NRS child assessment.

American Indian - Alaska Native program representatives should attend the Training-of-Trainers session assigned to the region in which their program is geographically located. The Training-of-Trainers for Migrant and Seasonal Farm Workers programs will take place in spring, 2004.

In addition to the online registration process, participants may register using the attached hard-copy form. Hard-copy registrations received after June 20 will be assessed the standard $250 registration fee. Early hard-copy registrations and all online registrations will receive a $25 discount. Paper forms may be submitted in two ways:

Fax registrations to 202-742-5394, ATTN: NRS Logistics Specialist

Mail registrations to ESI, NRS Logistics Specialist, 1150 Connecticut Avenue NW, Suite 1100, Washington, DC 20036

REGISTRATION
Step 1: Check the box next to the ONE SESSION you wish to attend. Some Regions are grouped together, and some Regions offer two sessions, either on different days of the week, or concurrently. Each participant will attend only one session.

Note: Requests to participate in a Training-of-Trainers event outside of one's region will be considered on an individual basis.

Puerto Rico programs only - San Juan (Tuesday-Thursday)	July 16-18
Regions I and II - Boston Session 1 (Monday-Wednesday)	July 21-23
Regions I and II - Boston Session 2 (Thursday-Saturday)	July 24-26
Region III - Philadelphia (Wednesday-Friday)	August 13-15
Region IV - Atlanta Session 1 (Monday-Wednesday)	July 21-23
Region IV - Atlanta Session 2 (Thursday-Saturday)	July 24-26
Region V - Chicago Session 1 (Monday-Wednesday)	August 11-13
Region V - Chicago Session 2 (Thursday-Saturday)	August 14-16
Region VI - Dallas Session 1 (Monday-Wednesday)	August 4-6
Region VI - Dallas Session 2 (Thursday-Saturday)	August 7-9
Regions VII and VIII - Denver (Monday-Wednesday)	August 4-6
Regions IX and X - San Francisco Session 1 (Tuesday-Thursday)	July 29-31
Regions IX and X - San Francisco Session 2 (Tuesday-Thursday)	July 29-31

Step 2: Complete the following information about EACH participant.
Mr./Ms. Full Name Badge name / Nickname (first name only)

Organization:

Professional title:

Work address:

City State:

Zip code:

Work phone:

Work fax:

Work email:

Registration forms must include the correct 10-digit grant number in order to be processed:

Street address for shipping (if different from above)

Spanish local NRS training -

Yes, I will be responsible for training local staff on the Spanish version of the NRS child assessment.

Therefore, I will be participating in the Spanish assessment Training-of-Trainers sessions.

Need American Sign Language interpretation? (Yes/No)
Yes
No

Please describe any access needs:

Dietary Restrictions? (Check all that apply)
Vegetarian
Low salt
Gluten free
Vegan
Dairy free

Please describe any additional special needs:

Please check all your primary duties:
Supervisor of teachers and/or home visitors or education manager
Early Literacy Mentor-Coach
Child development and education services
Classroom teacher
Staff trainer/staff developer
Technology support
Disabilities services manager
Consultant
Administration/management
Other

Step 3: Include -

Registration fee:

$225 - hard-copy registration received by June 20 or online registration
$250 - hard-copy registration received after June 20

After July 1st only online or on-site registrations will be accepted.

1) Enclosed is:
Check
Money Order
Original PO (you will be invoiced)

Please make payable to "Educational Services, Inc." for the "Head Start NRS" and include a copy of the attendee's registration form.

2) Please charge:
MasterCard
Visa

Credit card number:

Name on card:

Expiration date:

Signature:

Daytime telephone number:

See also:
Implementation of the Head Start National Reporting System on Child Outcomes (ACYF-IM-HS-03-07)