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Country Select Country 1728270Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo The Democratic Republic Of The Cook Islands Costa Rica Cote D'Ivoire (Ivory Coast) Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia The Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey and Alderney Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong S.A.R. Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea North
Korea South Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau S.A.R. Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Man (Isle of) Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles Netherlands The New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Occupied Panama Papua new Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts And Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent And The Grenadines Saint-Barthelemy Saint-Martin (French part) Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia South Sudan Spain Sri Lanka Sudan Suriname Svalbard And Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Vietnam Virgin Islands (British) Virgin Islands (US) Wallis And Futuna Islands Western Sahara Yemen Zambia Zimbabwe
State Select State 1728269
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Would the attendee like to utilize Spanish interpretation? Please select Yes No
What is the attendee’s company or organization type? What is your company or organization type? Licensed Child Care Center Licensed Family Child Care Home Public or Charter School Nonprofit Community-Based Organization Public or Governmental Agency Head Start Program Higher ed Institution Corporate or Private Business not providing Child Care Family, Friend, or Neighbor Child Care Foundation Home Visiting Program/Agency Other Other
What is the attendee’s position type? What is your position type? Child Care or School Owner/Director/Assistant Director Early Childhood Education Lead Teacher Early Childhood Education Assistant Teacher/Paraprofessional Family Child Care Home Provider Early Childhood Special Educator Family, Friend, and Neighbor Caregiver Early Childhood Education Student, Instructor, Associate Professor, or Professor Parent or Other Caregiver Coach Advocacy or Policy Professional State, Council, School District, Foundation, or other Systems Building Professional Mental Health Professional Family Support or Special Serivices (OT, PT, SLP) Professional Home Visitation Professional (Home Visitor, Parent Educator, Supervisor, Coordinator, Other) Other Other
Which Home Visitation Model do you work in? Please select Parents as Teachers (PAT) HIPPY Both PAT and HIPPY Other home visiting model (please specify)
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What age group does the attendee work with on a daily basis? What age group do you work with on a daily basis All ages Adults Infant Only Infant & Toddler Infant – PreK Infant - Kinder Infant – School Age Toddler Only Toddler – PreK Toddler - Kinder Toddler – School Age Early Childhood Home Visiting- Prenatal–5 years and Caregivers/Parents) PreK Only PreK - Kinder PreK - School Age Kinder Only Kinder - School Age School Age Only
Which of the following best describes the attendee’s age? Which of the following best describes your age? 18-24 25-34 35-44 45-54 55-64 65 and over Prefer not to disclose
What is the attendee's highest level of education? What if your highest level of education Some high school, no diploma High school diploma or GED Some college, no degree Trade school Associate’s Bachelor's Master's Doctorate Prefer not to disclose
Which of the following best describes the attendee’s race? Which of the following best describes you? Asian Black or African American Hispanic or Latino Native American or Alaska Native Native Hawaiian or Pacific Islander White Multiracial Other Race Prefer not to disclose
Which gender does the attendee most identify with? Which gender do you most identify with Female Male Non-binary Other Gender Prefer not to disclose
Which of the following best describes the attendee's average compensation/income before taxes? Which of the following best describes your average compensation/income before taxes Less than $20,000 $20,000 to $34,999 $35,000 to $49,999 $50,000 to $74,999 $75,000 to $99,999 Over $100,000 Prefer not to disclose
How did you hear about RMECC? How did you hear about RMECC? I have attended in the past A coworker, colleague, or friend Denver's Early Childhood Council newsletter or email Colorado Department of Early Childhood newsletter or email State licensing department (outside Colorado) A sponsor or partner organization's email, social media, or other communication Other Other Other
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