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Workforce Pathways Project Alameda County
Interest Form Fiscal Year 20-21
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* Indicates required question
Email
*
Your email
*Fields must match your W-9
Last Name
*
Your answer
First Name
*
Your answer
Middle Initial
Your answer
Primary Telephone Number
*
Your answer
Choose one
*
Cell
Home
Work
Alternative Phone number
*
Your answer
Choose one
*
Cell
Home
Work
Workforce Registry Id # (Required)
*
Your answer
Current Employment
Program/Site Name (Agency and Specific Program site)
*
Your answer
Facility License Number (optional)
Your answer
City
*
Your answer
Zip Code
*
Your answer
What is your position? (Select ONE)
*
Site Supervisor
Program Director
Assistant Director
Owner/Operator
Assistant/Aide
Associate Teacher
Teacher
Master/Head Teacher/Lead Teacher
Substitute
Are you employed at a licensed or license-exempt early childhood education program in Alameda County for at least the previous 12 months?
*
Yes
No
Where you employed at an ECE Program in Alameda County before March 16 2020 and your employment status was negatively impacted by COVID-19?
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Yes
No
Which best describes this program/worksite? (Select ONE)
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Private Child Care Center
Family Child Care Home
State Funded Preschool Program
Early Head Start Program
Head Start Program
How many hours per week do you work at the program/worksite listed above?
*
Your answer
Ages served
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Infants (Birth to 17 months)
Toddlers (18 to 35 months)
PreK (36 months to Kindergarten entry)
Required
Is your program participating in Quality Counts Alameda?
*
Yes
No
Does your program serves Dual Language Learners?
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Yes
No
Does your program serves children from low-income families/child care voucher-subsidies? Receive child care payments from 4Cs of Alameda, Bananas, Hively or Davis St.
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Yes
No
Does your program/site serves children with special needs or disabilities
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Yes
No
What is the primary language you speak with children in the classroom? (Select ONE)
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Arabic
Armenian
Cantonese
English
Farsi
Filipino (Tagalog or Pilipino)
Hmong
Japanese
Punjabi
Korean
Mandarin
Portuguese
Vietnamese
Russian
Sign Language
Spanish
Other:
Operator/Director's Full Name (First Name & Last Name)
*
Your answer
Operator/Director's Email
*
Your answer
Employment Self-Certification
*
I hereby certify that I am currently employed at the program/site identified above, that I work at least 15 hours per week
I understand that, by June 30 2021, I must have worked at an ECE Program in Alameda County for the last 12 months
In addition, I verify that I work directly with children 0-5 years or supervise individuals that do
Required
Workforce Pathways
Workforce Advising Pathway
*
I understand that in order to be eligible to participate of the Workforce Pathways Project I must have an annual Professional development plan created with a CA Mentor Teacher and/or an annual Professional Growth Plan completed with the appropriate ECE College Advisor
Workforce Higher Education Pathway - options (choose the pathway you are interested in pursuit, select just one)
*
At this moment I am not interested in pursuing higher education courses
I will be pursuing higher education courses in topics related to Early Care and Education/Child Development that are not listed above
Teaching in a Diverse Society & CA Foundations: Math + Science + Visual Arts (Spanish ONLY) - Las Positas College
Administration I: Programs in Early Childhood Education & Administration II: Personnel and Leadership in Early Childhood Education - Chabot College (you must have all the prerequisites)
Infant/Toddler Development and Care & Curriculum and Environments for Infants and Toddlers - Merrit College
A copy of your responses will be emailed to the address you provided.
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