OEC Registry - State Training Registry (Version 1.0)

User Registration

*Required Field

Salutation:

First Name:

Middle Name:

Last Name:

Maiden/Former Last Name:

Email Address:

Re-Type Email Address:

Address 1:

Address 2:

Zip:

City:

State:

Daytime Phone:

Evening Phone:

Social Security Number/Individual
Identification Number:

Date of Birth:

What year did you start in the early childhood field?

Are you currently employed?

Yes No

Demographic Information

The following information is voluntary, but it will help us to get a full picture of our Early Childhood Workforce. Refusal to provide this information will have no effect on any decision to provide services except where disability may be used to establish eligibility for a benefit or service. The information will be kept confidential as required by law and will only be used for statistical purposes in accordance with the law. For any questions about the use of your data, please refer to the Registry Policy Statement on Privacy.
Gender:*
What is your marital status?*
How would you describe your ethnic background?*
How would you describe your racial makeup from these options?*
Primary language?*

I have read and agree to provide my contact information in accordance with the
Terms of Use and Privacy Policy.

For individuals with confirmed employment in an early care and education program:
I understand that the Privacy Policy indicates program staff with administrative access
to the Registry can view my documents on file. I can view these at any time under My
Documents.

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