ITS-SIDS Train-the-Trainer Course |

Applicant information
Complete all of the fields. If any questions are not answered, the application will not be considered and you will be asked to resubmit. Please keep answers concise and respond to the questions asked. Staff from the NC Resource Center may ask you to provide evidence to support your answers upon review of your application.
Name*
First Last
County or counties served*
List the names of the county(ies) you currently serve with in-person training sessions. Please do not put a region number.
Job title*
Agency/Organization name*
List "independent" if not affiliated with an agency/organization.
Agency/Organization address, including the city, state, and zip code*
If independent, a personal address can be provided.
Work phone*
Email*
If you are already trained by the Resource Center and have been assigned a trainer number or a CCHC number, please provide it below.

Copy and paste this link to look up your trainer number: https://healthychildcare.unc.edu/wp-content/uploads/sites/17234/2021/07/Trainer-Master-with-Numbers.xlsx
Have you successfully completed the NC Child Care Health Consultant Course?*
- Yes
- No
Are you actively working as a Child Care Health Consultant (CCHC)?
- Yes
- No

Application Questions
1. List your academic degrees and area of concentration*
REQUIRED: A degree in nursing or a bachelors degree in a health-related field or early childhood/child development.
2. Do you have professional knowledge of health and safety issues related to infants or toddlers?*
REQUIRED: This can include professional experience or college coursework
- Yes
- No
Describe your specific professional knowledge of health and safety issues related to infants/toddlers in child care:*
3. Do you have experience or education in providing adult training?*
Verification of current trainer status as a non-exempt trainer with the Division of Child Development and Early Education (DCDEE) or employment by an exempt training agency is required.
- Yes
- No
Describe your specific experience or education in adult training.*
4. Do you plan to train early educators in your community upon completion of the course?*
REQUIRED: To become a trainer, you must be willing to train early educators in your community, not only those that work in one facility.
- Yes
- No
Describe your target audience:*

Confirmation
Confirmation*
I confirm that all information submitted on this form is true and correct to the best of my knowledge.

ITS-SIDS Train-the-Trainer Course