Forms for Training Classes

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					South Carolina Department of Social Services
Division of Child Day Care Licensing and Regulatory Services

                             South Carolina Child Care Training System
                                 Request for Child Care Training Registration

Section I: Trainer

Name of Trainer:_                                                                  Job Title:

                                                                          City, State, Zip Code
Email address:

Mailing Address for Attendance Roster ( if different than above) Attn:

Daytime Phone Numbers: (            )                          (     )                     (      )     ____________
                             Work                                  Home                               Fax

Education:       (Check all that apply and specify degrees earned)
     High School Graduate                                  AA Degree in
     ABC Credential                                        BA/BS Degree in
     CDA (indicate Year)                                   MA Degree in
     Technical College Certificate in ECD                  PhD Degree in
     Technical College Diploma in ECD                      Other: (Specify)

Expected Training Site:

Sponsoring Organization and Location:

Target Audience:       (Check all that apply)

         Preschool Caregivers                Infant-Toddler Caregivers        Food Service or Support Staff
         Owners / Administrators            School Age Caregivers             Other: (Specify)_   __________       ________

Section II: Training: Please attach the Outline Format to this form when submitting to CCCCD.

Title of
Choose only 1 topic area for each outline submitted. A separate registration form and outline must be submitted
for a different topic area.

Clock hours:                Growth and Development             Clock hours:               Program Administration

Clock hours:                Curriculum                         Clock hours:               Special Needs

Clock hours:                Health and Safety                  Clock hours:               Child Guidance
                                                               Please note: DSS requires training to be documented as
Clock hours:                Nutrition                          clock hours. Participants must remain in session for the
                                                               full length of time requested on this form. Clock hours
                                                               exclude breaks and lunch.
Clock hours:               Professional Development
     All training classes must be at least 1.0 hour in length and may not exceed 6.0 hours to qualify for DSS credit.

                                         Return this form and outline format to:
                                          Center for Child Care Career Development
                                          PO Box 5616, Greenville, SC 29606-5616
                                                  Toll free 1-866-845-1555

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