January - March 2021 Registration for Early Intervention 101 Virtual Presentation

Complete this registration form to participate the upcoming NYCDOHMH Bureau of Early Intervention Virtual Presentation.

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* 1. Are you a:

Parent

Provider

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* 2. Enter First Name:

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* 3. Enter Last Name:

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* 4. Email address

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* 5. What is your job title /position? (If applicable)

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* 6. What is the name of the organization you represent?

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* 7. Organization Address

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* 8. Zipcode

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* 9. What date do you plan to attend Early Intervention 101 Virtual
Presentation?

Date 1/19/2021 is closed

Date 2/10/2021 is closed

Date 2/17/ 2021 is closed

Date 2/23/2021 is closed

Date 2/26/2021 is closed

Date 3/11/2021 is closed

Date 3/16/2021 is closed

Date 3/23/ 2021 is closed

Date 3/31/2021 is closed

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* 10. Does your organization provide services to families with children 0-3 years?

Yes

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* 11. How did you hear about this Early Intervention Virtual Training?

Community Partnership Meeting

Supervisor/Colleague

DOHMH employee

Other

January - March 2021 Registration for Early Intervention 101 Virtual Presentation

Question Title

* 1. Are you a:

Question Title

* 2. Enter First Name:

Question Title

* 3. Enter Last Name:

Question Title

* 4. Email address

Question Title

* 5. What is your job title /position? (If applicable)

Question Title

* 6. What is the name of the organization you represent?

Question Title

* 7. Organization Address

Question Title

* 8. Zipcode

Question Title

* 9. What date do you plan to attend Early Intervention 101 Virtual Presentation?

Question Title

* 10. Does your organization provide services to families with children 0-3 years?

Question Title

* 11. How did you hear about this Early Intervention Virtual Training?

* 9. What date do you plan to attend Early Intervention 101 Virtual
Presentation?