PDI | Infant/Toddler CDA | Career Development Center

First Name:

Last Name:

Email:

Phone:

Work County: What county do you primarily / usually work in? If unemployed, what county do you live in?

Aspire Registry ID: (optional) What is this?

Address:

City / State / Zip :

Please fill out the following information about your education.

SUNY Student ID: required only if you have ever attended a SUNY school and have a SUNY Student ID

CUNY EMPLID ID: required only if you have ever attended a CUNY school and have a CUNY EMPLID

Please provide additional information about your degrees.

Highschool / GED:

School Name:

Graduation Year:

School Location:

Diploma/transcript have been translated and evaluated
Diploma/transcript have been translated but not evaluated
Diploma/transcript have not been translated or evaluated

Associate's Degree:

Type:

College System:

Institution Name:

Campus:

Diploma/transcript have been translated and evaluated
Diploma/transcript have been translated but not evaluated
Diploma/transcript have not been translated or evaluated

Major:

Graduation Year:

Bachelor's Degree:

Type:

College System:

Institution Name:

Campus:

Diploma/transcript have been translated and evaluated
Diploma/transcript have been translated but not evaluated
Diploma/transcript have not been translated or evaluated

Major:

Graduation Year:

Master's Degree:

Type:

College System:

Institution Name:

Campus:

Diploma/transcript have been translated and evaluated
Diploma/transcript have been translated but not evaluated
Diploma/transcript have not been translated or evaluated

Major:

Graduation Year:

In order to participate in this program, all students must be eligible for employment in a child care facility. Please indicate your status for the following requirements

I have been fingerprinted by OCFS to work in a licensed child care facility
I need to be fingerprinted by OCFS in order to be eligible to work in a licensed child care facility

I have been cleared through the NYS SCR Clearances to be eligible to work in a licensed child care facility
I need to be cleared through the NYS SCR Clearances to be eligible to work in a licensed child care facility

I have proof of my current immunization records
I need to obtain proof of current immunizations

I have proof of a current medical exam on the required OCFS form
I need proof of a current medical exam on the required OCFS form

Required Training

Check all that apply

I have a current Infant/Child CPR Certification
I have a current First Aid Certification
I have completed the Child Abuse and Maltreatment Certification Training
I have completed SIDS training
I have completed the Shaken Baby training

Status:

Current Role: Select the option that best matches your current role

Other Title:

Experience: How many years experience do you have working with young children?

Current Employer: Organization / program name

Employer Address:

City / State / Zip :

I agree that all information provided on this pre-application is true to my knowledge and understand that if something is falsified, I will be disqualified from participation
I have shared the above information and expectations of the program with my director and have their permission to apply for enrollment if accepted

Select*:

CUNY Campus: Which CUNY campus did you learn about us from?

Other / Detail: (optional)

Funded Credit bearing Infant/Toddler CDA

Personal / Contact

Education / Qualifications

Employment Eligibility

Current Employment

Permissions

How did you hear about the Program?