Update Trainer Contact Information |

Trainer Number*

Email Address*

Enter Email Confirm Email

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Email Address

Please provide an email address we can use to contact you if we have any questions concerning your updated contact information.

Select from the list below which contact information you would like updated:

First Name
Last Name
Agency
Phone Number
Email

Once the field opens, enter your new contact information.

First Name

Last Name

Agency

Phone Number

Email

Have you recently completed the EPR or ITS-SIDS Course for Trainers or the EPR or ITS-SIDS Course for Trainers Refresher with the NC Resource Center?*

Yes
No

If you have completed the EPR or ITS-SIDS Course for Trainers or the EPR or ITS-SIDS Course for Trainers Refresher in the last two weeks, please list the cohort number for the course you most recently completed*

Indicate whether you are considered an exempt or non-exempt trainer, based on the Division of Child Development and Early Education's definition.*

Exempt
Non-Exempt

Would you like to have your contact information listed on our website?*

If you select no, you will be listed on the website with your name, county/ies served, and trainer number only.

Yes
No

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Update Trainer Contact Information

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