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The Oregon Registry Enrollment form plays a crucial role for those involved in childhood care and education within the state. This form enables individuals to enroll in the Oregon Registry Online system, designed to help track professional development activities. Key sections of the form collect essential personal information, including names, contact details, and demographics, allowing the Child Care Division to maintain updated records. Optional data regarding racial and ethnic background, as well as primary and secondary languages spoken, facilitates inclusivity efforts within the system. Another section demands information about an individual’s employment or volunteer position, level of education, and the facility they're associated with, whether it’s a child care center, public school, or family child care provider. Further, the form asks about licensing status and child age groups served, ensuring a comprehensive view of the professional landscape in Oregon’s early childhood education sector. Lastly, by signing the form, applicants authorize the sharing of their information with designated organizations, reinforcing a transparency commitment while protecting confidentiality. Overall, the Oregon Registry Enrollment form is not just a bureaucratic step; it is a vital tool for fostering a well-trained and diverse workforce dedicated to the care and education of children.

Oregon Registry Enrollment Example

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
Get Oregon Registry Enrollment PDF Form

Form Characteristics

Fact Name Details
Purpose of the Form The Oregon Registry Enrollment Form is designed for individuals to enroll in the Oregon Registry Online system, which helps track their professional development in childhood care and education.
Governing Laws The enrollment process is governed by Oregon Administrative Rules (OAR) related to Child Care, specifically OAR 414-300-0010 through 414-300-0300.
Individual Information Section 1 collects essential personal details including names, date of birth, physical address, and contact information. Accuracy is crucial for maintaining the registry's effectiveness.
Optional Information Section 2 is optional and aims to gather information regarding racial/ethnic background and language skills, which assists in improving inclusivity efforts within the registry.
Workforce Information In Section 3, information about the individual's position and educational background is gathered to better understand the workforce in childhood care and education.
Employment Details Section 4 requires details regarding the facility where the individual works or volunteers, including whether it is licensed by the Child Care Division, facilitating better oversight.
Childcare Facility Check Section 5 asks specific questions about the childcare facility’s licensing status, the maximum number of hours children may attend, and age groups worked with, enriching data collection for childcare standards.
Authorization Statement Section 6 includes an authorization statement, requiring the applicant's signature. This ensures the disclosure of personal information is limited to authorized bodies within Oregon’s childcare management system.

Guidelines on Utilizing Oregon Registry Enrollment

After completing the Oregon Registry Enrollment form, you will have successfully enrolled in a system that helps track your professional development in childhood care and education. The information you provide will assist in managing your training records and ensuring you meet licensing requirements. Follow these steps to fill out your enrollment form correctly.

  1. Begin with Section 1: Individual Information. Fill in your last name, first name, and middle name. Indicate your gender and date of birth (mm/dd/yyyy). If you have any former names, list them here.
  2. Provide your physical address, including street address, apartment number (if applicable), city, state, zip code, and county of residence. If your mailing address is different, fill in that information as well.
  3. List your city of birth, home phone number, work phone number, fax number, and email address.
  4. Proceed to Section 2: Optional Enrollment Information. Here, you can check the racial/ethnic background that best describes you. If you do not identify with the listed options, select "OTHER" and write in your preference.
  5. Answer what your primary language is. If you speak any other languages fluently, indicate "Yes" or "No," and list those languages if applicable. Also, state the language you speak most often with the children you work or volunteer with.
  6. Next, in Section 3: Workforce Information, select your position from the list provided. You’ll also need to indicate your level of education by checking the appropriate option and providing details if applicable.
  7. In Section 4: Employment/Volunteer Information, choose the type of facility where you work or volunteer. Provide the name, phone number, and physical address of the facility. Don’t forget to include the county.
  8. Move on to Section 5: Childcare Facility Information. Answer whether the facility is licensed by the Child Care Division, and if so, check the type and provide the license number.
  9. Indicate your work setting and the maximum number of hours and months per year a child may attend the facility. Lastly, select the age groups of children you work with.
  10. Finally, in Section 6: Enrollment Authorization, read the statement, then sign and date the form to authorize the disclosure of your information to the necessary parties.

What You Should Know About This Form

1. What is the purpose of the Oregon Registry Enrollment form?

The Oregon Registry Enrollment form enrolls individuals in the Oregon Registry Online (ORO) system. This system is designed to help track professional development in the field of childhood care and education. By enrolling, you can monitor your training and educational records, ensuring compliance with licensing requirements and supporting your career growth.

2. What information do I need to provide on the form?

The form requires personal information such as your name, date of birth, physical address, and contact details. You will also be asked about your employment or volunteer position, education level, and the type of childcare facility you are associated with. There is also an optional section for demographic information to help the program track its inclusivity efforts.

3. Is there any information I can skip on the form?

Yes, certain sections of the form are optional. For instance, demographic information regarding racial or ethnic background and language skills can be left blank if you choose not to disclose that information. However, providing this optional data can help enhance the inclusivity of the program.

4. What types of employment or volunteer positions does this form cover?

The form includes a wide range of positions related to childhood care and education. This includes roles like teacher, nanny, administrative support, and various other capacities within child care centers and schools. If your title isn’t listed, there is an option to write it in.

5. How will my information be used once I submit the form?

Your information will be managed within the ORO system to track your training and educational records. It will be shared only with authorized personnel from various Oregon agencies involved in child care. These representatives prioritize confidentiality and will not disclose your information for any unauthorized purposes.

6. What if I am unsure about the licensing status of my facility?

If you are uncertain whether the facility you work or volunteer for is licensed by the Child Care Division, you can select "Don’t know" on the form. However, it may be helpful to inquire with the facility administration to gain clarity on its licensing status, as this information is a critical part of your enrollment.

7. What is the next step after submitting the enrollment form?

Once you submit the form, your information will be reviewed by representatives from the Oregon Registry Online system. You will receive confirmation of your enrollment and access information for your training and professional development records. Keep an eye on your email for updates regarding your enrollment status.

Common mistakes

Filling out the Oregon Registry Enrollment form can be straightforward, but there are common mistakes that individuals often make. These errors can delay the enrollment process and create unnecessary complications.

One common mistake is neglecting to provide complete individual information. Missing details such as a last name, date of birth, or an incomplete address can lead to difficulties in processing the enrollment. This information is essential for accurately tracking professional development and ensures that communication reaches the right individual.

Another frequent error involves the optional enrollment information section. Some individuals skip this section entirely or do not fully engage with the questions posed, such as not listing languages spoken or omitting racial/ethnic background. While this information is optional, providing it can help the Oregon Registry better understand and serve diverse populations.

In addition, people sometimes incorrectly identify their current position or the type of facility where they work. The choices available may be limited or specific, and selecting an inaccurate option can lead to data mismatches. This misrepresentation may affect eligibility for certain resources or assistance.

Lastly, individuals often overlook the importance of signing and dating the form. A signature indicates consent for disclosure of personal information and enrollment authorization. Omitting this signature renders the application incomplete, necessitating re-submission and further delay in processing.

Documents used along the form

The Oregon Registry Enrollment form is essential for childhood care and education professionals in Oregon. Along with this form, several other documents may be necessary to complete the enrollment process. Below is a list of commonly used forms and documents that support the enrollment and documentation procedures.

  • Central Background Registry Application: This form requests a background check for individuals working or volunteering with children. It helps ensure the safety of child care environments.
  • Child Care License Application: Required for individuals or facilities seeking official licensure to operate a child care service. It provides details about the facility and compliance with state regulations.
  • Emergency Preparedness Plan: This document outlines procedures for handling emergencies at child care facilities. It is crucial for ensuring the safety and well-being of children in care.
  • Health and Safety Training Certificate: A record of completed training focused on health and safety in child care settings. This certificate often includes topics like CPR and first aid.
  • Professional Development Plan: A plan that outlines educational and training goals for individuals in the child care field. It helps track ongoing professional growth.
  • Employment Verification Form: This document validates an applicant’s work history and experience in child care. It often includes references from previous employers.
  • Informed Consent Form: This form is used to inform parents or guardians about the risks and benefits associated with specific child care services. It obtains their consent for participation.
  • Child Health Assessment: A document assessing a child’s health status and developmental milestones. It assists caregivers in understanding and addressing individual needs.
  • Service Agreement: This agreement outlines the services provided by the child care facility and the terms regarding fees and responsibilities of each party.
  • Training Records: A compilation of certificates and documentation of completed training sessions and workshops relevant to child care practice.

Completing the Oregon Registry Enrollment process is vital for those in the child care field. Each supporting document plays a significant role in ensuring compliance, safety, and the promotion of professional development.

Similar forms

  • Child Care Provider Application: Similar to the Oregon Registry Enrollment form, this application collects personal and professional information to assess qualifications and eligibility for child care services. Both documents require details about the individual’s identity, work experience, and educational background.
  • Background Check Authorization Form: This form also gathers personal identification details to verify an individual’s history. Like the Oregon Registry form, it aims to ensure the safety and suitability of individuals who work in child care settings.
  • Professional Development Tracking Form: This document tracks training and educational achievements, similar to the Oregon Registry's role in managing professional development records. Both forms help individuals keep a record of their progress in the child care field.
  • Employment Application for Child Care Positions: Similar in purpose, this application seeks information regarding personal details, work history, and qualifications. Both forms help determine the suitability of individuals for roles in child care and education.

Dos and Don'ts

When filling out the Oregon Registry Enrollment form, attention to detail is important. Below is a list of things to do and avoid.

  • Do: Provide accurate personal information including your full name and date of birth.
  • Do: Fill out optional racial/ethnic background questions to help the Registry track inclusivity.
  • Do: Include a valid email address for all future communications regarding your enrollment.
  • Do: Check for spelling errors to ensure that all names and addresses are correct.
  • Do: Sign and date the form to authorize the disclosure of your information.
  • Don't: Skip any required fields, as failure to complete mandatory information may delay your enrollment.
  • Don't: Use nicknames or informal names when filling out the form; full legal names should be used.
  • Don't: Provide incorrect or outdated contact information, as it may hinder communication.
  • Don't: Leave the signature section blank, as it invalidates the form.

Misconceptions

There are several misconceptions surrounding the Oregon Registry Enrollment form. Understanding the truth can help applicants navigate the process with greater ease. Here are nine common misconceptions:

  1. The Form is Compulsory. Some people believe that completing the Oregon Registry Enrollment form is mandatory. In reality, it is optional and intended primarily for those who would like to track their professional development.
  2. All Information Must Be Provided. There's a misconception that every section must be filled out completely. However, providing optional enrollment information is encouraged but not required.
  3. Your Information is Public. Many worry that their personal data will be publicly available. This is not true; the information is kept confidential and only shared with authorized personnel.
  4. You Can't Change Your Information. Some believe that once the form is submitted, their information is set in stone. In fact, individuals can request updates or changes to their information at any time.
  5. Enrollment is Only for Child Care Workers. There is a misconception that only individuals working directly in child care can enroll. In truth, anyone involved in childhood care and education can participate, including volunteers and administrative staff.
  6. You Need a High Level of Education to Enroll. Individuals may think they need advanced degrees to qualify for the Oregon Registry. However, the enrollment welcomes all levels of education, including those who may not have completed high school.
  7. The Form is Too Complicated. Some prospective enrollees feel intimidated by the form’s length. While it may seem detailed, it is designed to gather necessary information efficiently and is straightforward to fill out.
  8. Submitting the Form Means I Have a Job. A common misunderstanding is that filling out the form implies employment. The enrollment does not guarantee job placement or offer employment itself.
  9. It Takes a Long Time to Process. Many people fear that the enrollment process is slow. In reality, once submitted, most enrollments are processed promptly, allowing individuals to access resources quickly.

Clearing these misconceptions can empower individuals interested in professional development within the childhood care and education field. Understanding the nature and purpose of the Oregon Registry Enrollment form makes the application process smoother.

Key takeaways

Filling out the Oregon Registry Enrollment form is straightforward, but a few key points can enhance your understanding of the process.

  • Personal Information Matters: Ensure that all personal details, such as your name, address, and contact information, are accurate and complete. This information helps maintain up-to-date records in the Oregon Registry system.
  • Optional Information: Section 2 allows you to provide optional enrollment information. While it is not mandatory, your participation assists in tracking inclusivity and better understanding the demographic makeup of early childhood professionals.
  • Identify Work and Volunteer Roles: Clearly select your position and describe the childcare facility you work or volunteer for. This information is crucial in categorizing your professional development needs and resources.
  • Understand the Confidentiality Policy: By signing the enrollment form, you consent to the use of your information for training and professional development. Your data will remain confidential and accessible only to authorized personnel.

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