OMB Control Number: 0970-0617
Expiration date: 09/30/2026
Office of Child Care Tribal Cluster Meeting: Registration Questions
All fields followed by * are required.
Please select your role at this event. * (drop down list)
Tribal CCDF Administrator
Tribal CCDF Lead Agency Staff
Tribal Fiscal Staff
Federal Employee
OCC National Center TA Staff (drop down list)
Child Care Automated Reporting System (CARS)
Child Care Meeting Management Center (CMC)
Child Care State Capacity Building Center (SCBC)
Data and Information Systems Consultation Center (DISCC)
National Center on Afterschool and Summer Enrichment (NCASE)
National Center on Early Childhood Quality Assurance (NCECQA)
National Center on Subsidy Innovation and Accountability (NCSIA)
Tribal Child Care Capacity Building Center (TCBC)
Tribal Child Care Program Support Center (TPSC)
Invited Presenter or Guest
Other
Please specify ______________
Contact Information
First Name *
Last Name *
Title/Position *
Organization or Tribe/Tribal Organization *
City *
State *
Zip Code*
Telephone Number *
Email Address *
OCC Region * (drop down list)
Region 1 (CT, MA, ME, NH, RI, VT)
Region 2 (NJ, NY, PR, VI)
Region 3 (DC, DE, MD, PA, VA, WV)
Region 4 (AL, FL, GA, KY, MS, NC, SC, TN)
Region 5 (IL, IN, MI, MN, OH, WI)
Region 6 (AR, LA, OK, NM, TX)
Region 7 (IA, KS, MO, NE)
Region 8 (CO, MT, ND, SD, UT, WY)
Region 9 (AS, AZ, CA, GU, HI, MP, NV)
Region 10 (AK, ID, OR, WA)
N/A
Are you a Public Law 102-477 Grantee?
☐ Yes
☐ No
☐ Unsure
Do you require any special accommodations?
☐ Yes
Please specify ______________
☐ No
Will you be staying at the meeting hotel?
☐ Yes
☐ No
☐ Unsure
Emergency Contact Information
Emergency Contact Name:
Emergency Contact Telephone Number:
Emergency Contact Email Address:
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Cassell, Stacy (ACF) |
File Modified | 0000-00-00 |
File Created | 2024-11-13 |