First Name: Last Name: M.I.: Student ID:
Mailing Address: City: State: Zip:
Phone (H): Phone (W): Phone (C):
Date of Birth:
Gender:
M F
Email Address:

Are you a U.S. Citizen: Y N

Are you a Hispanic/Latino: Y N

Race (Select one or more)
American Indian or Alaskan Native
Asian
Black or African American
White
Native Hawaiian or Other Pacific Islander

Education(highest completed):
High school diploma, GED or HiSet
Some college/no credential
Credential < 2-year degree (< associate degree)
Associate degree
Bachelor's degree
Master's degree or higher

Are you currently employed: Y N

Please select a Breakout Session Below for each time:

11:10-12:10p-Breakout Session I
Option 1: CEI Business Labs-Opening Your Own Childcare Business
Option 2: Working at a Family vs Center Child Care Provider

1:30-4:00p- Breakout Session II
Option 1: CPR and First Aid for Child Care Providers with MMG Safety
Option 2: Grow Your Skills-Interviewing, Dress to Impress, and Resume Writing

Please indicate dietary restrictions or preferences:

Do you have any accessibility of accommodation requests?

By Clicking the `Apply Now` button below I certify that all information on this application is accurate and complete.

Careers with Kids Event

Non-Discrimination Policy

Northern Maine Community College is an equal opportunity/affirmative action institution and employer. For more information, please call (207) 768-2791