Name __________________________

Month for which you are requesting credit _______________

Address ______________________________________________________

City, State, Zip: ____________________________________

Phone __________________________________

E-Mail __________________________

1. Check at least 3 of the following areas in which you feel that you increased your child care skills through your use of the materials this month.

1. Planning and preparation of activities
2. Building your children’s self-esteem
3. Providing choices for your children
4. Helping your children develop physical fitness
5. Encouraging your children to use creative thinking
6. Helping your children develop fine motor skills
7. Planning and organizing a field trip
8. Utilizing community resources to help teach a unit
9. Teaching your children to follow directions
10. Encouraging good nutritional habits
11. Helping your children develop language skills
12. Providing hands on activities
13. Involving parents in your program
14. Learning to be flexible in your activities and programming
15. Helping your children to learn to accept responsibility
16. Providing a regular routine for your children

Describe briefly the way in which this learning took place for you for each of the learning experiences that you checked.

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2. Which teaching units did you present this month? _____________________________________________

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3. List at least one activity that you did with the children in each of the following skill areas to show that you used a variety of coordinated activities in presenting the units to the children:

Language Skills: _________________________________________________

Science: _________________________________________________

Music: _________________________________________________

Large Muscle Skills: _________________________________________________

Fine Motor Skills: _________________________________________________

Creative Art: _________________________________________________

Listening Skills: _________________________________________________

Number Skills: _________________________________________________

4. Describe at least 1 way in which you tried to promote self-esteem through the activities that you developed with the children this month. _____________________________________________

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5. Describe a learning center or independant activity area that you set up during one of the teaching units this month.? 

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6. What activities that you developed with the children this month were most satisfying for your?

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Signature                                           Date              Invoice #

Training Credit Offered By Your State Per Month Used: _____________

Training hours for self-directed study are available in many states. If you are unsure whether your state offers credit towards licensing training requirements for the use of self-directed study materials, check with your licensing agent. Providers in Texas receive 5 clock hours for each month of curriculum used.

Fill out the form above.

Sign and date the form.

Enter your invoice # from the your sales slip (credit is available only for purchasing customer.)

Enter the number of credit hours available for using one month of curriculum. (Customers in Texas enter 5. Other customers, please check with your licensing agent.)

Mail the completed form to our office.

We will mail you a certificate to keep in your records.