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Family and Social Services Administration

Bureau of Child Care Home > Provider Resources > Professional Development > Online Child Care Learning (CCL) > Childcare Learning > Student Information Student Information

The Indiana Family and Social Services Administration and its partners continue to seek opportunities to deliver high quality instruction and certification to child care providers throughout Indiana. There are many traditional educational programs in Early Childhood available to childcare providers. However, many providers still struggle to take advantage of these educational opportunities. An Online Child Development Associate (CDA) credential is now available to meet the needs of providers in areas of the state with little or no access to traditional education. Students can take these classes when it is convenient and when they have access to a computer.

Steps to Formal Application - Students

Date
Name
Female Male
Birth Date
Address
City
State
Zip
County
Phone (home)
Phone (work)
E-mail
Fax

Section 1: Childcare Employment Status

  • Who is your employer?
  • What is your job title?
  • How many hours do you work per week?
  • What age group do you provide care for?
  • Date of employment at current workplace?
  • What is your current hourly rate of pay?
  • Number of children in your classroom/home?

Section 2: Family Structure (this information will be used for demographic purposes only)

How many people live in your household?
List everyone in your household and their relationship to you. (Include yourself)
Name
Relationship
Name
Relationship
Name
Relationship
Name
Relationship

Section 3: Ethnicity: Do you consider yourself . . . ?

White/European American
Black/African American
Hispanic/Latino/Latina
Asian/Pacific Islander
Bi-racial
American Indian (tribe)
Other

Section 4: Child Care Center / Home Information

  • Name of Child Care Center / Home
  • License/Registration Number
  • License/Registration Capacity
  • Center Address and County
  • Center E-mail:

Section 5: Educational Background

  • High School
Yes No
  • Dates Attended
  • Diploma (select one)
Yes No
  • GED (select one)
Yes No
Please leave BLANK if not applicable
College/University




Dates Attended




Major(s)




Degree or Credit Hours




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