Early Care & Learning and Specialized Training Application
Page 1
To translate the form into Spanish or another language (
Para traducir el formulario al español u otro idioma):
Open the form using Google Chrome web browser.
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(Abra el formulario con el navegador web Google Chrome.
Descarga Chrome aquí
.)
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Select “Translate to …” (Selecciona "Traducir a ...".)
Choose the language you would like it to be translated to. (Elija el idioma al que le gustaría que se tradujera.)
Repeat steps 2-4 on each new form page. (Repita los pasos 2 a 4 en cada nueva página de formulario.)
A. Application Type
Is this an Initial Application, Updated Application, Specialized Training, or Expedited Request?
Initial Application
Updated Application
Specialized Training* (Please attach any credentials/licenses that qualify you to teach this training)
Expedited Request**
B. Personal Information
First Name
Middle Initial
Last Name
Date
Phone
Email
Organization/Affiliation
Mailing Address
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip Code (5-digit)
Title of Training
*If training requires a certificate, please attach with this application.
C. Training Information
Target Audience (check all that apply):
Child Care Home/Group Home
Child Care Center
Early/Head Start
Pre-K/School District
School Age
Trainers
Parents/Families
Child Care Administrators
Approved Provider
Military
Tribal
Lead Teachers
Support Staff
Health, Safety, Nutrition Staff
Other
Other
Target Audience Size:
Training Length (hours):
Training Type:
In-house training
Open to the community
E-learning
Training is Conducted in:
One session
Multiple sessions
Please elaborate on multiple sessions
Type of Delivery:
Face-to-face
Hybrid***
Asynchronous****
Other
Other
Check all age groups for which this training applies:
Prenatal
Infant (birth through 18 months)
Toddler (19 through 36 months)
Preschooler (3 through 5 years, not in school)
School age (6 through 12 years)
Youth (13 through 18 years)
All age groups
Special Needs
Adult Learning
Administrators
Staff
Other
Other
D. Documentation
Please submit any supporting documentation here.
Upload file
Footnote & Signature
*Specialized Training refers to training outside of early care and learning, such as a tax workshop or healthcare training, that meets specific professional or industry standards.
**Applications will be processed in order of receipt within 30 business days. An expedited request may be submitted 2 weeks in advance of training.
***Hybrid means some of the content is in a classroom with a trainer and some is online.
****Asynchronous refers to self-paced courses that allow participants to go through on their own with little to no help from an instructor.
Acknowledgment
I attest that the information provided above is true and accurate to the best of my ability.
Signature
Page 2
Instructional Plans for Early Care & Learning and Specialized Training Approval Application
Please complete instructional plan below and ensure your plan covers all required components. Submit instructional plan with your completed application form from page 1.
Click
here
to see examples of how to complete an instructional plan for training approval.
Instructional Plan Option:
Early Care & Learning
Specialized Training
Early Care & Learning Instructional Plan
A. Training Outcomes:
B. Learning Methods
(check all that apply)
:
Lecture
Audio/visual materials
PPT and/or handouts
Hands-on activities
Small and/or large group discussions or activities
Opportunities to ask questions
Reflection
Games
Demonstration
Other
Other
C. Assessment Tool
D. Evaluation Tool
E.
Alaska Early Childhood Core Knowledge and Competencies
(CKC)
F.
Alaska Early Learning Guidelines
(ELG) (If applicable)
Specialized Training Instructional Plan
A. Training Outcomes:
B. Learning Methods
(check all that apply)
:
Lecture
Audio/visual materials
PPT and/or handouts
Hands-on activities
Small and/or large group discussions or activities
Opportunities to ask questions
Reflection
Games
Demonstration
Other
Other
C. Assessment Tool
D. Evaluation Tool
E. Statement of Understanding
By submitting and signing this application:
I certify that the information on this application is true and accurate to the best of my knowledge.
Signature
Date
Applications will be processed in order of receipt within 30 business days.