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Outline

The Oregon Registry Enrollment form serves as a crucial gateway for professionals in the field of childhood care and education. By completing this form, individuals can enroll in the Oregon Registry Online system, which plays an essential role in tracking their professional development. The form is divided into several sections, each gathering important information. Section 1 focuses on individual details, such as your name, date of birth, and contact information. It also allows for updates to your address with the Central Background Registry. Section 2 is optional and collects demographic information to promote inclusivity. In Section 3, applicants detail their workforce information, including job titles and educational background. Section 4 delves into employment and volunteer roles, providing insight into the facilities where individuals work or volunteer. Lastly, Section 5 addresses specific childcare facility information, ensuring that all necessary licensing details are captured. The final section, Section 6, includes an enrollment authorization that emphasizes the confidentiality of the provided information. By signing this form, applicants consent to the management of their training and education records, paving the way for a more organized approach to their professional growth.

Sample - Oregon Registry Enrollment Form

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
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Form Information

Fact Name Details
Purpose The Oregon Registry Enrollment form is designed to enroll individuals in the Oregon Registry Online system, which helps track professional development in childhood care and education.
Governing Law This form operates under Oregon state regulations concerning early childhood education and care, specifically the Oregon Administrative Rules (OAR) related to the Child Care Division.
Personal Information Section 1 requires individuals to provide personal details such as their name, gender, date of birth, and contact information.
Optional Demographics Section 2 collects optional demographic information to promote inclusivity and track diversity within the workforce.
Workforce Information In Section 3, applicants specify their job position, level of education, and any relevant certifications or degrees they hold.
Facility Information Section 4 focuses on the facility where the individual works or volunteers, including its licensing status and type.
Childcare Facility Licensing Section 5 asks whether the facility is licensed by the Child Care Division and details the type of license it holds.
Confidentiality Section 6 emphasizes that the Oregon Registry Online system ensures the confidentiality of personal information, accessible only by authorized personnel.
Signature Requirement The form must be signed by the applicant to authorize the disclosure of their information for professional development tracking.

Detailed Guide for Filling Out Oregon Registry Enrollment

Completing the Oregon Registry Enrollment form is an important step toward tracking your professional development in childhood care and education. Once you fill out the form, it will be submitted to the appropriate authorities for processing. Here’s how to fill it out step by step.

  1. Section 1: Individual Information
    • Enter your last name, first name, and middle name.
    • Select your gender.
    • Provide your date of birth in the format mm/dd/yyyy.
    • If applicable, list any former names.
    • Fill in your physical address, including street address, apartment number, city, state, zip code, and county of residence.
    • If your mailing address is different, provide that information as well.
    • List your city of birth.
    • Provide your home phone number, work phone number, fax number, and email address.
  2. Section 2: Optional Enrollment Information
    • Select your racial/ethnic background from the options provided. If none apply, check "Other" and write in your preference.
    • Indicate your primary language.
    • Answer whether you speak any other languages fluently, and if so, list them.
    • State the language you use most often with the children you work with.
  3. Section 3: Workforce Information
    • Select your position from the list provided.
    • Indicate your level of education by checking the appropriate box and providing additional details if necessary.
  4. Section 4: Employment/Volunteer Information
    • Choose the option that best describes the facility you work or volunteer for.
    • Provide the name of the facility and its contact information.
    • If applicable, provide the mailing address of the facility.
  5. Section 5: Childcare Facility Information
    • Indicate if the facility is licensed by the Child Care Division.
    • If licensed, specify the type of facility.
    • List the facility’s license number if known.
    • Describe your work setting and the maximum hours children may attend.
    • Indicate the age groups of children you work with.
  6. Section 6: Enrollment Authorization
    • Read the authorization statement carefully.
    • Sign the form, print your name, and date it.

Obtain Answers on Oregon Registry Enrollment

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

    The Oregon Registry Enrollment form is designed to enroll individuals in the Oregon Registry Online (ORO) system. This system serves as a valuable tool for tracking professional development in the field of childhood care and education. By completing this form, you can ensure that your training and education records are managed effectively, which is essential for meeting licensing requirements and enhancing your professional growth.

  2. What information is required to complete the enrollment form?

    To fill out the Oregon Registry Enrollment form, you will need to provide several key pieces of information:

    • Your personal details, including your name, date of birth, and contact information.
    • Optional demographic information, which helps track inclusivity efforts.
    • Your professional role and level of education in the field of childhood care and education.
    • Details about your employment or volunteer work, including the type of facility you are associated with and whether it is licensed.

    While some sections are mandatory, others are optional and are collected for statistical purposes.

  3. How is my personal information protected when I enroll?

    Your privacy is a top priority. The Oregon Registry Online system takes necessary precautions to ensure that only authorized personnel can access your confidential information. The form includes a section that outlines how your data will be used and shared, primarily for licensing requirements and professional development tracking. Confidential information will not be disclosed for any purposes outside of those specified unless required by law.

  4. Can I update my information after I have enrolled?

    Yes, you can update your information at any time. If you change your address or any other personal details, it is important to notify the Child Care Division. The enrollment form includes a section where you can request updates to your address on file for the Central Background Registry. Keeping your information current ensures that you receive important communications and that your records remain accurate.

Common mistakes

Filling out the Oregon Registry Enrollment form can be a straightforward process, but several common mistakes can lead to complications. Awareness of these pitfalls can help ensure a smooth enrollment experience.

One frequent error is the omission of essential personal information. Applicants sometimes forget to include their last name or first name, which can cause delays in processing. It is crucial to provide complete and accurate individual information to avoid unnecessary setbacks.

Another common mistake is failing to update the mailing address. If an applicant has moved recently, they should indicate whether the mailing address differs from the physical address. Neglecting this step can result in important communications being sent to the wrong location.

In Section 2, optional enrollment information is often overlooked. While this section is not mandatory, providing details about racial or ethnic background can contribute to tracking inclusivity efforts. Applicants should consider completing this section to support broader initiatives.

When listing languages spoken, individuals may forget to specify their primary language or fail to indicate additional languages they speak fluently. Accurate language representation is vital, especially for those working with diverse populations.

Section 4 requires applicants to describe their employment or volunteer facility accurately. Some individuals mistakenly select the wrong category or fail to provide the facility’s name. This information is essential for aligning professional development with the appropriate context.

Another frequent error occurs in Section 5, where applicants may not confirm whether their facility is licensed by the Child Care Division. Failing to answer this question correctly can lead to misunderstandings regarding compliance and eligibility for certain programs.

Applicants often neglect to check the maximum number of hours per day or the months a child may attend the facility. These details are important for understanding the service’s capacity and ensuring alignment with regulatory requirements.

Lastly, a significant mistake is not signing the form. The signature is a critical component of the enrollment process. Without it, the application cannot be processed, leading to delays in accessing the Oregon Registry Online system.

By being mindful of these common mistakes, individuals can enhance their chances of a successful enrollment in the Oregon Registry Online system. Taking the time to review each section thoroughly will facilitate a smoother experience.

Documents used along the form

The Oregon Registry Enrollment form is essential for individuals working in childhood care and education. However, several other documents are commonly used alongside it to ensure compliance, facilitate communication, and track professional development. Below is a list of forms and documents that are frequently associated with the Oregon Registry Enrollment process.

  • Background Check Authorization Form: This document allows the Oregon Child Care Division to conduct a background check on individuals applying for positions in child care. It includes personal information necessary for the check.
  • Child Care Provider Application: This application is required for individuals seeking to operate a licensed child care facility. It gathers information about the applicant, the facility, and its operations.
  • Training Verification Form: This form is used to document completed training and professional development activities relevant to child care. It is essential for maintaining licensing and registry requirements.
  • Emergency Contact Form: This document lists emergency contacts for children in care. It is crucial for ensuring the safety and well-being of children during emergencies.
  • Child Enrollment Form: This form collects information about children enrolled in a child care program, including medical history, allergies, and emergency contacts.
  • Facility License Application: Required for new child care facilities, this application provides details about the facility's operations, staff qualifications, and compliance with state regulations.
  • Health and Safety Checklist: This checklist is used to ensure that child care facilities meet health and safety standards. It covers various aspects such as sanitation, food safety, and emergency preparedness.
  • Staff Training Log: This log tracks the training and professional development of staff members. It is important for maintaining compliance with licensing requirements.
  • Incident Report Form: This form is used to document any accidents or incidents that occur within the child care setting. It is essential for maintaining safety standards and for reporting to regulatory bodies.
  • Policy Handbook: This document outlines the policies and procedures of a child care facility. It serves as a guide for staff and parents regarding expectations and protocols.

These documents collectively support the goals of the Oregon Registry and enhance the overall quality of care provided in early childhood education settings. Proper management and completion of these forms contribute to a safe, compliant, and effective child care environment.

Similar forms

The Oregon Registry Enrollment form shares similarities with several other documents used in professional settings, particularly in the field of childhood care and education. Below is a list of these documents, highlighting their similarities:

  • Child Care Provider Application: Like the Oregon Registry Enrollment form, this application collects personal and professional information to assess qualifications for child care providers.
  • Background Check Authorization Form: Both forms require personal details to facilitate background checks, ensuring the safety and well-being of children in care.
  • Professional Development Tracking Form: This document, similar to the Oregon Registry Enrollment form, is used to monitor and record training and education progress for individuals in the child care field.
  • Employment Application: Much like the Oregon Registry Enrollment form, this application gathers essential information about an applicant's work history and qualifications for a specific role.
  • Child Care Licensing Application: This application also requires detailed information about the applicant and their facility, similar to the information requested in the Oregon Registry Enrollment form.
  • Volunteer Registration Form: Both forms collect personal information and details about the applicant's role, ensuring that all individuals working with children are properly documented.

Dos and Don'ts

When filling out the Oregon Registry Enrollment form, it's important to ensure accuracy and completeness. Here are some guidelines to follow:

  • Do double-check your personal information. Make sure your name, address, and contact details are correct.
  • Don’t leave any required fields blank. Missing information can delay your enrollment.
  • Do provide your Registry number if you have one. This helps to link your information correctly.
  • Don’t forget to include your primary language. This information helps in providing better services.
  • Do list any additional languages you speak. This can be beneficial for your professional development.
  • Don’t skip the optional sections. While they are not required, they help track inclusivity.
  • Do sign and date the form. Your signature confirms that the information provided is accurate.
  • Don’t submit the form without reviewing it. A final check can catch any errors or omissions.

Following these tips can make the enrollment process smoother and more efficient. Good luck with your application!

Misconceptions

Understanding the Oregon Registry Enrollment form can be tricky. Here are nine common misconceptions that people often have about this important document:

  • It’s mandatory to fill out all sections. Many believe that every section of the form must be completed. In reality, some sections, such as optional enrollment information, are not required.
  • My personal information will be publicly accessible. There is a concern that personal details will be shared widely. However, confidentiality is prioritized, and information is only accessible to authorized personnel.
  • Only child care providers need to enroll. Some think that only those directly providing child care must fill out the form. In fact, anyone involved in childhood care and education can benefit from enrollment.
  • The form is only for licensed facilities. It’s a misconception that only licensed child care providers can enroll. Even volunteers or those working in unlicensed settings can complete the form.
  • Updating my address is unnecessary. Some individuals may overlook the importance of updating their address. Keeping this information current is crucial for receiving important communications.
  • Enrollment is a one-time process. Many believe that once they enroll, they never need to update their information again. Regular updates are essential to maintain accurate records.
  • My enrollment will not affect my career. Some individuals think that enrolling in the Oregon Registry has no impact on their professional development. In reality, it can open doors to training opportunities and resources.
  • Language information is mandatory. There is a belief that you must disclose your primary and additional languages. This section is optional and meant to help track inclusivity.
  • The form is only for those working with young children. While the focus is on childhood care, individuals working in various educational roles can also benefit from enrolling.

Clearing up these misconceptions can help individuals navigate the enrollment process more effectively and understand the benefits of being part of the Oregon Registry Online system.

Key takeaways

Filling out the Oregon Registry Enrollment form is an important step for professionals in childhood care and education. Here are key takeaways to consider:

  • The form enrolls individuals in the Oregon Registry Online system, which tracks professional development.
  • Section 1 requires personal information, including name, gender, and contact details.
  • Updating your address for the Central Background Registry is an option during enrollment.
  • Section 2 is optional and collects demographic information to promote inclusivity.
  • Individuals can specify their racial/ethnic background or choose "Other" to describe themselves.
  • Language proficiency is addressed, allowing you to list your primary and additional languages.
  • Section 3 focuses on workforce information, detailing your position and education level.
  • Employment and volunteer details are captured in Section 4, including the type of facility you work for.
  • Section 5 asks about the child care facility’s licensing status and the age groups of children you work with.
  • Authorization in Section 6 allows for the sharing of your training and education information with authorized personnel.

Completing this form accurately ensures that your professional development is recognized and helps improve the quality of childhood education in Oregon.