Application Request Form

Our continuing education course is targeted to child health or early childhood professionals interested in becoming child care health consultant trainers. We recruit teams of trainers from each state and US territory to attend our program and learn how to train child care health consultants (CCHCs) directly. NTI program graduates become trainers of CCHCs and return to their areas to set up training programs for health consultants. Teams from every state have been through our training.

We are looking for applicants with the following qualifications:

  • active child health, child care, and/or early childhood education professionals;
  • recent experience in or with out-of-home child care;
  • part of a system, either public or private, with the potential for supporting a CCHC training program on a regional, state or local level; and
  • experience with face-to-face training of child health, child care, or early childhood education professionals.

Before submitting this form, please make sure you have fully read the above information and the information on the previous Criteria for Applicants page. Keep in mind that NTI only trains CCHC trainers; we do not offer training for health consultants directly. Please note that the form below is just a request for an application--an additional full application must be submitted in order to attend the training. By submitting this form, you will be placed on a waiting list and will receive an application for the next available training session if you meet eligibility requirements.

Red items are required.

Name:
Employer:
Street Address/P.O. Box:
City:
State:
Country (Required if non-US address):
Zip:
Business Phone:
Fax Number:
Email Address:
How did you learn about NTI?
Which professional organization/association(s)
are you affiliated with?