JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Roots of Resilience Online Course Scholarship Application Spring/Summer 2021
Please complete the following information for our Roots of Resilience Online Course.
* Indicates required question
Email
*
Your email
First and Last Name
Your answer
Work site
Your answer
Is this?
home-based child care/preschool
child care/preschool center
Head Start
Other:
Clear selection
County of work site
Crook
Deschutes
Jefferson
Other:
Clear selection
What city do you work nearest to?
Your answer
How many children do you care for?
Your answer
How would you describe your gender identity?
Your answer
How would you describe your racial/ethnic identity?
Your answer
What language(s) do you speak with the children you work with?
Your answer
Have you participated with Roots of Resilience before?
Workshop
Coaching
Focus group
Online Course
Webinar
None
Other:
Clear selection
Would you also like a hard copy of the coursebook? If yes, please include your mailing address here:
Your answer
How would you like your instructor to contact you? (check all that apply)
email
text
phone call
Other:
What can our team do to best support you in accessing or completing this online course?
Your answer
Any additional questions about Roots of Resilience?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Oregon State University.
Report Abuse
Forms
