CDA Application: Part B
Thank you for your interest in the CDA, please complete this supplemental application to be considered for the CDA scholarship.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What Type of CDA are you seeking?
*
Preschool
Infant/Toddler
Family Child Care
Renewal
What county do you live in?
What county do you work in?
Are you currently employed?
Yes
No
Seeking employment
Do you have experience working in a licensed child care facility?
Yes, I currently work in a child care.
Yes, I used to work in a child care
I have not worked in child care before.
What language/s do you speak
Arabic
Chinese
English
French
German
Hindi
Japanese
Korean
Russian
Spanish
Swahili
Tagalong
Vietnamese
American Sign Language
Dari
Farsi
Karen
Kinyarwanda
Persian
Please indicate your income level:
less than $20,000
$20,000 - $34,999
$35,000 - $49,999
$50,000 - $74,999
$75,000 - $89,999
$90,000 +
Are you currently Early Childhood Teacher or Director qualified?
Yes
No
Do you currently have or have you had a CDA?
No
Yes- currently have a CDA, it is going to expire in the next 6 months
Yes- have had a CDA in the past, it has expired
Other
Employer Name
Employer address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Have you taken any of the following:
ECE 101
Expanding Quality in Infant Toddler Training
Pre Service training
Other ECE Courses
First Aid/CPR
None
Do you currently have PDIS account?
Yes
No
Please explain why you would like to obtain or renew your CDA credential.
Submit
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