CICC PARENTING EDUCATION REPRESENTATIVE APPLICATION FORM: Center for the Improvement of Child Caring. 25 years of focused research and development has proven CICC as one of America's largest and most influential parenting and parenting education organizations.We welcome you to the most complete repository of parental training materials, programs, workshops and seminars.

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CICC PARENTING EDUCATION REPRESENTATIVE
APPLICATION FORM

Check one:	Individual Representative	Organization Representative

For Persons Applying to be an Individual Representative

Your Email Address

Work Email Address


For Groups Applying to be an Organization Representative

Director/President
Name of Group

Address		City/State/Zip
Home Phone		Home Fax

Your Email Address
Website Address


For All Applicants

1. Which individuals or groups would you be encouraging to attend workshops, purchase materials or contract for parenting seminars and classes? (Be very specific in terms of individuals and organizations who you will contact, including their geographic locations)

2. We need to know about your personal, professional or organizational commitment to parenting education. For example, if you have become committed to the education and training of parents by yourself having benefited from parenting education classes or seminars, let us know. If you or your organization has already been trained to deliver parenting services or has a long history of educating and training parents, let us know. Or, if you think that training and educating parents is a great idea and that you want to become committed by being a parenting instructor or parenting representative, tell us. Your job is to convince us of the genuineness and nature of your commitment. So please let us know in your own words:

To confirm that your information has been sent to the CICC staff for processing, you will be returned to the CICC Home Page after it has been transmitted.

CENTER FOR THE IMPROVEMENT OF CHILD CARING
6260 Laurel Canyon Blvd, Suite 304
North Hollywood, CA 91606
(818) 980-0903 -- FAX: (818) 753-1054