Office of Child Care School-Age Child Care Institute Registration Questions

Administration for Children and Families Generic for Information Collections related to Gatherings

OCC School-Age Institute Registration Questions_fnl

Office of Child Care School-Age Child Care Institute Registration Questions

OMB: 0970-0617

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OMB Control Number: 0970-0617

Expiration date: 09/30/2026

OCC School-Age Child Care Institute: Registration Questions


Meeting Registration


All fields followed by * are required.

Please select your role at this event. * (drop down list)

  • Federal Employee

  • State CCDF Administrator

  • Territory CCDF Administrator

  • State CCDF Staff Member

  • Territory CCDF Staff Member

  • OCC National Center TA Staff

  • 21st Century Community Learning Center State Coordinator

  • State Afterschool Network Lead

  • Invited Presenter or Guest

  • Other

    • Please specify ______________


Contact Information

First Name *

Last Name *

Title *

Division/Department*

Organization *

City *

State *

ZIP Code *

Phone Number *

Email *

Emergency Contact Name

Emergency Contact Phone Number

Emergency Contact Email

OCC Region * (drop down list)

  • Region I (CT, MA, ME, NH, RI, VT)

  • Region II (NJ, NY, PR, VI)

  • Region III (DC, DE, MD, PA, VA, WV)

  • Region IV (AL, FL, GA, KY, MS, NC, SC, TN)

  • Region V (IL, IN, MI, MN, OH, WI)

  • Region VI (AR, LA, OK, NM, TX)

  • Region VII (IA, KS, MO, NE)

  • Region VIII (CO, MT, ND, SD, UT, WY)

  • Region IX (AS, AZ, CA, GU, HI, MP, NV)

  • Region X (AK, ID, OR, WA)

  • N/A


Do you require any special accommodations?

☐ Yes

Please Specify ______________

☐ No

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMaria Hrabak
File Modified0000-00-00
File Created2024-11-13

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