CDA Interest Form

Please review each CDA program type on the Trying Together website before submitting this form and identify which program best fits your educational needs. After completing the form, a member of our staff will contact you to determine your eligibility. Requests for information are answered on a first-come, first-served basis.

First Name *

Last Name *

Email *

Phone *

Are you completing this form on behalf of someone else? *

Program Information

Program Name *

Program Address *

Program City *

Program State *

Program Zip Code *

Program County *

Program Phone *

STAR Level *

Age Group(s) You Serve *

Infant
Toddler
Pre-k
Kindergarten
School Age
Adults
None of the Above

What is your position? *

Director Name *

Director Email *

Director Phone *

Coach Name

Elizabeth Foreman
Holly Cessna
Jillian Miller
Kathy Wolfe
Katie Streiff
Lindsey Perry
Nicole Paulovich
Perrinda Sandiford
Shawna Mohler
Jasmine Mercedes
Andrea Gardner
I don't have a coach.

Choose all that apply:

Pre-K Counts
Head Start
Early Head Start
NAEYC Accreditation
Family Child Care

Applicant Information

Race and Ethnicity *

Gender *

Address Line 1 *

Address Line 2 *

City *

County *

Zip *

State/Province *

This form is intended for individuals who live in Pennsylvania. Do you live in the state of Pennsylvania? *

CDA Information

Which age group are you interested in for your CDA credential?

Have you ever applied for a CDA credential? *

Have you ever applied for PDO funding? *

Do you have a high school diploma? *

What is your highest level of educational attainment? *

For Associate's Degree or higher, please state the name of your degree(s).

Are you currently working in early education? *

Number of years working in the early childhood field? *

Are you currently working in an Early Head Start classroom? *

Have you participated in an online course before? *

Do you have access to reliable internet/Wi-Fi and an electronic device? *

What types of electronic devices do you use? *

Pennsylvania PD Registry Number *

How did you hear about this?

Flyer/Brochure
Social Media
Trying Together Newsletter
Trying Together Staff
Trying Together Website
Online Search
Friend/Colleague
Another Organization
Other

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CDA Interest Form

Program Information

Applicant Information

CDA Information