10.26.24 Active Supervision "*" indicates required fields Personal InformationName* First Last Phone*Confirm Phone Number*Email* Enter Email Confirm Email Career InformationCenter/Site Name* Childcare Licensing Type*Type IType IIType IIIFCCHeadstartOtherSite Parish*Jefferson ParishOrleans ParishPlaquemines ParishSt. Bernard ParishOtherPosition / Role*OwnerDirector/Assistant DirectorLead TeacherAssistant TeacherFloaterOtherAge Group*Infant (Birth to 11 Months)Toddler (12 Months to 35 Months)Pre-K (36 Months to 5 Years)None of the aboveLA4 or B3 Classroom Teacher*LA 4PDGNone of the aboveHighest level of education/degree attainment*High School DiplomaSome collegeAncillary CertificateAssociate’s DegreeBachelor’s Degree or higherNone of the aboveYears of experience in the field*Less than one year1-3 years4-9 years10 or more yearsCommentsThis field is for validation purposes and should be left unchanged.
