CDA York County

I. General Information

Please fill out this form on your screen, and then print it and mail to the address at the bottom of this page.
Be sure to send a registration fee and other documents with the form, as specified in the red "Important" section at the bottom of this page.

II. Academic Information

III. Post High School Education
1. List all education institutions or trainings attended since high school.

2. Specific classes related to Early Childhood Development:

3. CPR Certified: YesNo    Expiration Date: 
4. First Aid Certified: YesNo   Expiration Date: 

IV. History and Interests:
Fill in all employment history, starting with the most current.
1-A.

1-B.

1-C.

2. What other experiences have you had with children?

3. Hobbies, interests, groups, clubs:

4. What are your immediate career goals?

5. What do you see yourself doing five years from now?

6. How did you hear about CDA York County?

V. Training Goals
I am interested in obtaining a CDA Credentia to be recognized as a professional by parents,
    staff, the community, and the State of Maine "Quality Standards."
I am interested in networking and sharing ideas with others.
I want to learn the latest teaching skills in helping young children reach their potential.
I want to work with special needs children.
I am enrolling to gain the formal education needed for state and federal child care licensing requirements.
I want to learn more about children to become a better parent.
I want to work with the families of young children as a supportive educator and resource.
I want a CDA Credential because i can continue to work with children and meet the Field Hours requirements.
I want to gain college credits toward an early childhood education college degree.
I want the CDA Credential because it is a nationally recognized credential.
Other reasons for wanting the Child Develoment Associate (CDA) Credential that were not mentioned above?
If so, what are they?

VI. For those who are currently working in a licensed child care setting:
Are you currently working with young children? YesNo
If yes.....
Name of child care program: 
Address: 
Phone: 
Name of Supervisor: 
Your Current Title: 
Type of Program:
Family day care
Center-based preschool
Center-based infants/toddlers
Center-based school age

VII. For those who are not currently working in a licensed child care setting
If you are new to the child care field or are not currently working with young children, we set students up in an internship
at a quality center to work directly with children (approximately 20 hours per week). Students in training are not paid
during the internship, but you will meet all the teaching requirements for your CDA Credential and gain quality experience in the field.

1. Would you be most interested in working with children ages
Birth to 18 months
18 months to 3 years
3 to 5 years
No preference or Multi-age

2. When you get your CDA Credential, do you see yourself working in
Center-based setting
Family child Care setting
Family Support worker
Undecided at this time

VIII. All students
CDA York County classes are held three hours per week.
Please check which place or time that would be most convenient for you.
1. Most convenient location:
Saco
Sanford
Westbrook

1A. Most convenient time for you:
Mornings
Afternoons
Evenings
Weekends

2. Do you speak any foreign languages?
Yes
No
If yes, what are they? Speaking:    Writing:

2A. Would you like to know more about getting a CDA Credential with a Bilingual Specialization? Yes      No

3. Do you need help with reading and writing? Yes      No

4. List the state(s) you have lived in, other than Maine (and years there):
State:       Dates: 
State:       Dates: 
State:       Dates: 

5. Please two references (at least one work-related):
A. Name: 
  Address: 
  Phone: 
  Relationship: 

B. Name: 
  Address: 
  Phone: 
  Relationship: 

I confirm that the information contained in this application is accurate:
Your name here will serve as your signature:
Name:    Today's Date: 

* Important  Please be sure to send with this application
   (1) the Financial Contract (click here for the financial contract for the course beginning in September 2011 in Adobe Acrobat Reader),
and here for the financial contract for the Course beginning in January 2012.
   (2) your check or money order for the non-refundable Registration Fee in the amount of $50 payable to CDA York County to
CDA York County, P.O. Box 512, Sanford, ME 04073.
   (3) You will also need to submit a copy of your high school diploma or GED. If you cannot find it, you will need to request
a copy from your high school.

                   For more information about our program, please click on one of the links below: