Oregon Registry Enrollment Form – Fill Out and Use This PDF

Oregon Registry Enrollment Form is a document that you can use to enroll yourself in the Oregon department of motor vehicles. When you complete this form and file it, the process is easy and quick.

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Oregon Registry Enrollment Form PDF Details

The Oregon Registry Enrollment Form is a great way to ensure that your child has access to the best education possible. The form is simple to complete, and provides all of the information needed to enroll your child in the Oregon Registry. Completing the form online is easy and takes just a few minutes. Be sure to fill out the form accurately, as this will help ensure that your child receives appropriate educational services. For more information on the Oregon Registry, be sure to visit our website today.

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Question	Answer
Form Name	Oregon Registry Enrollment Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	oregon resgistry, oregon registry step application

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OREGON REGISTRY ONLINE ENROLLMENT FORM

This form will enroll you in the Oregon Registry Online system, which is a tool you can use to track your professional development in the field of childhood care and education.

Section 1: Individual Information

Last Name			First Name			Middle Name

Gender Male	Female	Date of Birth (mm/dd/yyyy)		Former Name(s)

Physical Address	I would like the Child Care Division to update my address on file for the Central Background Registry. My Registry number is: R__________________
(street address, apt no)

City			State	Zip Code	County of Residence

Mailing Address (if different than above)

City			State	Zip Code	City of Birth

Home Phone No		Work Phone No		Fax No	Email Address

Section 2: Optional Enrollment Information

(Completing the information below is optional. It is collected in an effort to track our success in being inclusive of all populations)

Check below what racial/ethnic background best describes you. If you do not identify with any of the choices given, please check the OTHER box and list your preferred choice.

American Indian/Alaskan Native	Black or African American
Asian	Hispanic/Latino/Spanish

Other: (please list) ___________________________________

Native Hawaiian or other Pacific Islander White

1.What is your primary language?

________________________________________________________________________________________

2. Do you speak any other language(s) in addition to your primary language?	Yes	No
If yes, please list any other language(s) that you speak fluently:

________________________________________________________________________________________

3.What language do you speak most often with the children that you work or volunteer with?

________________________________________________________________________________________

Section 3: Workforce Information

What is your Position(s)?
Administrative Support	Director	Multi-Site Coordinator	Teacher
Aide 1	Driver	Nanny	Teacher’s Aide
Aide 2	Executive Director	Operator	Volunteer
Assistant 1	Education Coordinator	Provider	Other: (please list)
Assistant 2	Head Teacher	Substitute Provider
Consultant	Health/Mental Health Worker
Cook	Manager
Level of Education
Less than High School Diploma	High School Diploma	General Educational Development (GED)

Certificate from college, school, or professional association in: ____________________________________________

2-year college degree- AA/AS/AAS or other in:_________________________________________________________

4-year college degree- BA/BS or other in: _____________________________________________________________

Master’s degree- MA/MS/MED or other in: ____________________________________________________________

PhD, EdD or other doctoral degree in: ________________________________________________________________

Other (please list degree and field of study): _________________________________________________________________

Continued on back (signature required)

July 2014

Section 4: Employment/Volunteer Information

Check below what best describes the facility you work or volunteer for:

Child Care Resource & Referral College or University

EI/ECSE

Head Start and/or OPK Health or Mental Health Healthy Start ODE/CACFP Sponsor

Child Care Center/Preschool (for/not-for-profit child care and education) Parent (eg Nanny)

Relief Nursery

School District- Elementary or High School Education Family Child Care Provider (self-employed)

State of Oregon Child Care Division

Other: (please list) ______________________________

Name of Facility (list business name. If family child care, list provider’s name)

Facility Phone No

Facility Physical Address (street address, apt no, city, state, zip)

Fax No

Mailing Address (if different than above)

County

Section 5: Childcare Facility Information (Complete this section if you work/volunteer with children)

1.	Is the facility that you volunteer or work for licensed by the Child Care Division?
	Yes	No/Exempt	Don’t know
2.	If yes, check the type of licensed child care facility you are associated with:

Registered Family Child Care Home (RF)

Certified Family Child Care Home (CF)

3.If known, please list the facility’s license number: _____________________

Certified Child Care Center (CC)

4. Check below what best describes your work setting:

Child care center	Child’s own home
Provider’s home	K-12 school building

Other: (please list) _____________________________________________________

5. Check below the maximum number of hours per day a child may attend the facility:

Four hours or less

More than four hours

6. Check below the maximum number of months in a year that a child may attend the facility:

0-4 months

5-9 months

10-12 months

7. What age groups of children do you work with (check all that apply)?

Infant

Toddler

Preschool School-Age

None of the above

Section 6: Enrollment Authorization

Oregon Registry Online (ORO) is a system that will manage your training and education records for licensing requirements and personal professional development. ORO representatives will undertake all necessary precautions to ensure that only authorized personnel will be able to access confidential information. Confidential information will not be disclosed for any purposes other than described here and as authorized by law. By your signature, you consent to the disclosure of your individual contact and training/education information to authorized personnel with the Oregon Office of Child Care, Oregon Center for Career Development, Department of Human Services, and/or the Central coordination of Child Care Resource and Referral at the Teaching Research institute and local child care resource and referral programs.

______________________________	___________________________________	_____________________
Applicant’s Signature	Printed Name	Date Signed
		July 2014

How to Edit Oregon Registry Enrollment Form Online for Free

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Oregon Registry Enrollment Form fields to fill in

In the What is your primary language, Do you speak any other languages, Yes, What language do you speak most, Section Workforce Information, What is your Positions, Administrative Support Aide Aide, Director Driver Executive Director, Level of Education, MultiSite Coordinator Nanny, Teacher Teachers Aide Volunteer, and Less than High School Diploma box, note down the information you have.

part 2 to completing Oregon Registry Enrollment Form

The application will require particulars to easily fill out the part Less than High School Diploma, Continued on back signature, and July.

Oregon Registry Enrollment Form Less than High School Diploma, Continued on back signature, and July blanks to insert

You need to define the rights and obligations of both sides in paragraph Section EmploymentVolunteer, Child Care Resource Referral, Child Care CenterPreschool, Name of Facility list business, Facility Phone No, Facility Physical Address street, Fax No, Mailing Address if different than, County, Section Childcare Facility, Is the facility that you volunteer, Yes, NoExempt, Dont know, and If yes check the type of licensed.

stage 4 to entering details in Oregon Registry Enrollment Form

Look at the fields Child care center Providers home, Childs own home K school building, Check below the maximum number of, Four hours or less, More than four hours, Check below the maximum number of, months, months, months, What age groups of children do, Infant Toddler, Preschool SchoolAge, None of the above, and Section Enrollment Authorization and then fill them out.

Entering details in Oregon Registry Enrollment Form step 5

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Step 4: Get duplicates of your form. This can prevent possible future misunderstandings. We cannot look at or reveal your details, for that reason be sure it is safe.

Oregon Registry Enrollment Form – Fill Out and Use This PDF

Oregon Registry Enrollment Form PDF Details

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Oregon Registry Enrollment Form – Fill Out and Use This PDF

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