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CHDEV Appointment Questionnaire
Thank you for contacting the Child Development Resource Center. Please answer the following questions to set up an appointment.
An email will be sent to you either with possible appointment date or follow-up questions.
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* Indicates required question
Student ID (Enter 0000 if you are not a Peralta student)
*
Your answer
First and Last Name
*
Your answer
Phone Number (xxx-xxx-xxxx)
*
Your answer
Email Address
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Your answer
How did you hear about the CHDEV Resource Center? (Check all that apply)
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Your answer
Are you working/volunteering in the early childhood education field? Specify the agency/preschool if you are.
*
Your answer
What is your major?
*
Child Development
Undeclared
Other:
What is your educational background/status? (check all that apply)
*
Current Merritt/Laney/Berkeley City College/College of Alameda student
Returning Merritt/Laney/Berkeley City College/College of Alameda student
Attended other colleges with Child Development or Early Childhood Education courses
Completed AA degree from other colleges
Completed bachelor or higher degree from colleges/universities in the United States
Completed bachelor or higher degree from foreign collges/universities
Current high school student
Other:
Required
Do you have Child Development or Early Childhood Education courses from other colleges? If so, please list them, include both the course title and the college.
*
Your answer
Are you taking any Child Development course at Merritt this semester? If so, please list them.
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Your answer
Reason why you are taking Child Development courses. (check all that apply)
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Your answer
Career Goal
*
Your answer
Reason for the appointment (check all that apply)
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Advisory Guide / Assistance in Selecting CHDEV Courses
Student Education Plan (SEP)
First Time Child Development Permit
Upgrade Child Development Permit
Renew Child Development Permit / Seeking Professional Growth Advisor
CHDEV Work-Related Questions
Homework Assignment
Other:
Required
Would you like the appointment to be
*
in-person
virtual
Please provide your meeting time availability, include preferred days and times (at least 3 options)
*
Your answer
Special Request (e.g. Spanish or Mandarin Support, or with a specific counselor)
Your answer
Optional Survey: what modality (virtual, in-person, hybrid) is the class you are taking (if you are taking any)? What do you think?
Your answer
Optional Survey: Would you like to have a monthly social event where we can support each other? If so, which day of the week and what time of the day?
Your answer
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