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Wednesday, September 08, 2010  
 Create User Profile 
      Personal Information:    
* UserID:     
* Password:     
* Confirm Password:     
* First Name:     
Middle Initial:   
* Last Name:     
 * Preferred Contact Method:   
* Email:     
* Phone:     
Alternate Phone:   
Fax:   
   Address
      Home Address:
* Home Address 1:   
Home Address 2:   
Home Address 3:   
* City:   
* State: 
* Zip:   
      Complete if you are a Center, Center Staff or Internal Staff:
Business Name:   
 Work Address 1:   
Work Address 2:   
Work Address 3:   
 City:   
 State: 
 Zip:   
   County Designation :
      *If you are a Parent, or a Family Childcare Provider enter your county of residence.
      *If you are a Center, or a Center Staff enter your county of employment.
* County:     
   MNTRECC Information:
        Are you an enrolled member of a federally recognized tribe, or a first or second generation descendent of an enrolled member?
        Are you a licensed by a tribal government, funded by a tribal government, or are your services predominantly for Native American families.
   Personal Information:
All information you provide is public. You are not required to provide any information. We do ask that you voluntarily provide information on race/ethnicity and languages spoken to help us track class participation and determine if we are meeting the professional development needs of all individuals. We are committed to ensuring that there is equal access to all opportunities offered through the CCR&R system. Any information you provide will not be shared except in response to a specific data request for this information or in summary form.
License ID:  (REETAIN requires License ID or District Number)
Gender: 
* Ethnicity:   
 
   Languages Spoken:
English:

Other African: 
Spanish:

Other American Indian: 
Somali:

Other European: 
Lao:

Vietnamese: 
Russian:

Cambodian: 
Ojibwe:

Serbian/Croatian: 
Dakota:

American Sign Language: 
Arabic:

Other Language: 
Hmong:

Other Asian: 
 
   Interests:
Grants:   
REETAIN Grants:   
Training:   
  
      (If you have not been contacted within 2 business days of registering, please contact your local CCRR affiliate.)