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GEER/CT DOTS Online Program Requests
This form is utilized to collect requests for the GEER program and for CT DOTS Online/eObserve software. This information will help us determine your eligibility for GEER funded programs and/or to generate a quote for the CT DOTS Online/eObserve software.
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* Indicates required question
Email
*
Your email
Program Name
*
Your answer
Program Contact First Name
*
Your answer
Program Contact Last Name
*
Your answer
Program Contact Title
*
Your answer
Program Contact Phone Number
*
Please include area code.
Your answer
Program Contact Email if different
Your answer
Program Street Address
*
Your answer
Program City/Town
*
Your answer
Program Zip Code
*
Your answer
Early Childhood Program Registry Id
*
Please do not include hyphens or punctuation (Numbers only). The Early Childhood Program Registry Id is used to help us determine if your program is GEER-eligible.
Your answer
Is your program a family childcare program?
*
Yes
No
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