Wufoo

Your Information

Who are you?
Name * First Last
Email *

All notification is done through e-mail. If you do not have your own e-mail, please use one from someone you trust to give you the information that we will send.
Please confirm email address *

All notification is done through e-mail. If you do not have your own e-mail, please use one from someone you trust to give you the information that we will send.
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
EEC PQ Registry Number -required *

If you have not registered on EEC's Professional Qualifications Registry, please do so now. This is a requirement.

https://www.eec.state.ma.us/
PQRegistry/
Phone Number * ### - ### - ####
Date of Birth * MM / DD / YYYY
Are you currently working toward a college degree at North Shore Community College? *
yes - in Early Childhood Education yes - in another field no
Are you matriculated at North Shore Community College?
yes - in Early Childhood Education degree yes - in another degree field no- I'm not matriculated
Do you have a Bachelor's degree?
yes - in Early Childhood Education yes - in another field no
Your Program Information

Where do you work?
Name of Program Where You Work *
Program Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number * ### - ### - ####
EEC Program Number *

The EEC 'Program Number' is required - not the EEC license number - please check with your supervisor if you do not know the number.
What is your current position? *
Assistant Teacher Teacher Lead Teacher Group Leader Assistant Group Leader Site Coordinator Program Director or Administrator Family Child Care Educator Family Child Care Assistant Other (specify below)
Other:
Program type *
Center based preschool Center based Infant/Toddler Center based mixed age groups School Age Child Care Family Child Care Other
Does your program accept children who are considered 'High Need" by EEC? Answer yes or no *

EEC defines “high needs children” as children who have multiple risk factors that are linked to poor school and life outcomes such as: children and parents with special needs, children whose home language is not English, families and children involved with many state agencies, English language learners, children with parents who are deployed and are not living on a military base, recent immigrants, low-income households, parents with less than a high school education, children who are homeless or move more than once a year, and children in racial and ethnic communities that experience social exclusion." (ELCG, p13).
Choose Your Courses Carefully - Don't sign up for everything!

It is important to select courses that will advance your professional development and goals of your Individual Professional Development Plan (IPDP). If you have a college advisor or direct supervisor, please meet with them to help choose the course(s) that will be best for you.
Which college course(s) do you want to attend? *
ECE101: Child Growth & Development Sept - Dec., 2016 6:15-9:45 p.m. Lynn ECE101: Child Growth & Development - online January - March, 2017 online ECE101: Child Growth & Development - online April - June, 2017 ECE___ Introduction to CDA with Professional Portfolio - hybrid Sept - Dec., 2016 6:15-9:45 p.m. Danvers and online ECE246: Field Placement and Seminar 2 (must meet all prerequisites) September - Dec, 2016 6:30-8:30 p.m. Lynn ECE208: Infants and Toddlers at Risk September - Dec., 2016 6:15 - 9:45 p.m Danvers ECE206: Supervision and Administration of Child Care Programs Feb - April, 2017 online ECE202: Using the Expressive Arts with Young Children March - June, 2017 6:15 - 9:45 p.m. Lynn

Refer to the College Course Calendar on the R3P webpage for listings, dates and locations. Please be sure you can commit before signing up. IF YOU ARE ACCEPTED INTO A COURSE AND DO NOT SHOW UP, YOU MAY NOT BE CONSIDERED FOR FUTURE R3P OFFERINGS! If accepted, you will receive an e-mail confirmation within two weeks before the start of the course with specific details on the course.
Please certify that you have consulted with a college advisor or your supervisor to ensure that the course(s) you have selected are aligned with your Individual Professional Development Plan (IPDP).
*
I certify that the college course(s) I am applying for are related to the professional goals on my IPDP. I have not met with my supervisor to discuss my course selections. I do not have a direct supervisor. I do not have an IPDP.

EEC requires that all educators have an Individual Professional Development Plan (IPDP) that outlines the educator's goals. IPDPs should reflect one or more of the following goals:
1. Attaining a degree in early education or a related field,
2. Achieving enhanced competency as defined by EEC,
3. Attainment of the Child Development Associate (CDA) credential, or
4. Attainment of other certifications or credentials that demonstrate knowledge, skills, and abilities related to early education and out of school time competencies.
Why do you want to take the course(s) you have chosen? Check all that apply. *
To learn more about a specific topic or Core Competency area To advance in EEC Qualifications. (ie. to become Lead Teacher qualified) To work toward a college degree To work on a goal in my IPDP The course looks interesting My supervisor (or someone else) recommended it
Is there anything else you would like us to know about your application?
Do Not Fill This Out

Wufoo

Your Information

Your Program Information

Choose Your Courses Carefully - Don't sign up for everything!