Oregon Registry Enrollment Template

Oregon Registry Enrollment Template

The Oregon Registry Online Enrollment Form is designed for those seeking to track their professional development within the field of childhood care and education. By filling out this form, individuals can enroll in the Oregon Registry Online system, facilitating the management and documentation of their educational and training progress. It covers a wide range of personal information, optional demographic details for inclusivity tracking, workforce specifics, employment or volunteer data, and childcare facility particulars, ensuring a comprehensive registration process.

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The Oregon Registry Online Enrollment Form is a pivotal document for individuals seeking to navigate their professional journey within the realm of childhood care and education. With this form, applicants are ushered into the Oregon Registry Online system, a dynamic platform designed to meticulously track professional development milestones. Initially, the form collects basic individual information, including legal name, gender, date of birth, and physical address, ensuring the Child Care Division can maintain up-to-date records. More than just a repository for personal data, the form extends an optional section to gather demographic details, aimed at fostering an inclusive environment that acknowledges a diverse workforce. Furthermore, it delves into workforce specifics, asking entrants to specify their role, educational background, and the nature of their involvement with child care or educational facilities. The employment or volunteer section is especially noteworthy, requiring descriptors of the facility's type and licensing status—a crucial step for regulatory compliance and safety assurance. Completing the form signifies consent for the controlled sharing of sensitive information among authorized bodies, a necessary provision for upholding transparency and confidentiality in professional development tracking. Through this comprehensive enrollment process, the Oregon Registry Online Enrollment Form epitomizes a structured approach to professional growth within the child care and education sector.

Preview - 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

File Features

Fact Description
1. Purpose of the Form This form enrolls individuals in the Oregon Registry Online system for tracking professional development in childhood care and education.
2. Section 1 Content Collects individual information like name, gender, date of birth, address, and contact details.
3. Address Update Option Offers the option to update the Child Care Division with the applicant's address for the Central Background Registry.
4. Section 2 Purpose Gathers optional enrollment information to track inclusivity of all populations. This includes racial/ethnic background and language proficiency.
5. Section 3 Content Captures workforce information including position, level of education, and field of study related to childhood care and education.
6. Section 4 Information Describes the employment or volunteer facility, including potentially the type of facility, name, and contact information.
7. Childcare Facility Licensing Requests information on whether the childcare facility is licensed, and if so, the type of license and facility’s license number.
8. Childcare Setting Details Asks for specifics about the childcare setting, including location, hours of operation, and the age groups of children served.
9. Enrollment Authorization Section 6 requires applicant’s consent for disclosing their information to authorized personnel for professional development purposes.
10. Governing Law(s) The enrollment is regulated under the laws governing the Oregon Office of Child Care, Oregon Center for Career Development, Department of Human Services, and the Teaching Research Institute.

Detailed Steps for Using Oregon Registry Enrollment

Filling out the Oregon Registry Online Enrollment Form is a straightforward process designed to enroll individuals in a system that facilitates the tracking of their professional development in the field of childhood care and education. This step-by-step guide will cover all the necessary fields that need to be completed on the form. Once the form is filled out, it will enable access to a range of services and support offered by the Oregon Registry Online. The information provided will be used to update existing records and ensure that the enrollee's professional development is accurately tracked and supported.

  1. Start with Section 1: Individual Information. Fill in your last name, first name, and middle name.
  2. Choose your gender by checking the appropriate box for male or female.
  3. Enter your date of birth in the format mm/dd/yyyy.
  4. If applicable, write any former name(s) you have had.
  5. Provide your physical address, including street address, apartment number, city, state, and zip code. Also, indicate your county of residence.
  6. Check the box if you would like the Child Care Division to update your address on file for the Central Background Registry and provide your Registry number starting with R.
  7. If your mailing address is different from your physical address, fill in the respective fields.
  8. Enter your city of birth.
  9. Provide your home phone number, work phone number, fax number, and email address.
  10. Move to Section 2: Optional Enrollment Information. Check the racial/ethnic background that best describes you or specify another in the space provided.
  11. Indicate your primary language and, if applicable, any other languages you speak fluently.
  12. Specify the language you most often use with the children you work or volunteer with.
  13. In Section 3: Workforce Information, mark your position and the level of education you have attained. Include specifics regarding your degree if you choose "Other."
  14. For Section 4: Employment/Volunteer Information, describe the facility you work or volunteer for, provide the name of the facility, its phone number, physical and mailing addresses, and the county.
  15. In Section 5: Childcare Facility Information,
    • Indicate whether your facility is licensed by the Child Care Division.
    • Select the type of licensed child care facility you are associated with.
    • If known, enter the facility’s license number.
    • Describe your work setting and the maximum number of hours per day and months per year a child can attend the facility.
    • Check the age groups of children you work with.
  16. Complete Section 6: Enrollment Authorization by reading the consent statement carefully and signing at the bottom with your signature, printed name, and the date signed.

After completing these steps and reviewing your information for accuracy, you can submit the form to the appropriate address or website provided by the Oregon Registry Online. Doing so will finalize your enrollment process, thus incorporating you into the system that aims to support and track your professional development in childhood care and education.

Important Points on This Form

What is the Oregon Registry Online and how do I enroll?

The Oregon Registry Online (ORO) is a system designed to track professional development for individuals in the field of childhood care and education. To enroll, you need to fill out the Oregon Registry Online Enrollment Form, which collects details about your individual information, optional enrollment information for diversity tracking, workforce information, employment/volunteer information, childcare facility information, and includes an enrollment authorization section requiring your signature.

What information do I need to provide in Section 1: Individual Information?

In Section 1, you are required to provide your personal details including your last name, first name, middle name, gender, date of birth, any former names, your physical and mailing addresses, city of birth, home, work, and fax phone numbers, and your email address. There is also an option to update your address on file for the Central Background Registry by providing your registry number.

Is completing the Optional Enrollment Information necessary?

No, completing Section 2: Optional Enrollment Information is not mandatory. This section is designed to gather data on racial and ethnic diversity among registrants. It includes questions about your racial and ethnic background, primary language, additional languages spoken, and the language most often spoken with children in your care or education setting.

What workforce information is required in Section 3?

Section 3 asks for details about your current position(s), level of education, and specific field of study if applicable. It gives a variety of job titles and education levels to choose from and provides space for you to list any degrees not mentioned, along with the field of study.

Can you explain Section 4: Employment/Volunteer Information?

Section 4 requires information about your current place of employment or volunteer work. It asks for the type of facility, name of the facility, facility phone number, physical and mailing addresses, as well as the county. This section helps categorize the different environments participants work in, from child care centers to family child care providers.

What does the Childcare Facility Information section entail?

In Section 5, you'll need to indicate whether the childcare facility you're associated with is licensed, and if so, what type of license it holds. You're also asked to describe your work setting, the maximum number of hours and months a child can attend the facility annually, and the age groups of children you work with.

What is Section 6: Enrollment Authorization about?

Section 6 is your formal consent to the Oregon Registry Online for managing your training and education records. It outlines how your information will be used and protected, guaranteeing access only to authorized personnel for professional development and licensing requirements. It necessitates your signature, printed name, and the date you signed the document to be valid.

Who has access to my information after I sign up?

Your signed consent allows authorized personnel from the Oregon Office of Child Care, Oregon Center for Career Development, Department of Human Services, and the Central coordination of Child Care Resource and Referral at the Teaching Research Institute, as well as local child care resource and referral programs, to access your information. The purpose is strictly to manage your training, education records, and for other authorized uses as stated in the enrollment form.

Common mistakes

When filling out the Oregon Registry Online Enrollment Form, individuals often encounter several common mistakes that can delay or complicate their enrollment process. Paying attention to these errors can improve the accuracy and efficiency of form completion.

  1. Failing to provide complete contact information: In Section 1, individuals sometimes skip fields such as the email address or phone numbers. These details are crucial for ensuring effective communication and updates about their enrollment status.
  2. Incorrectly listing former names: The section on former names in Section 1 is frequently overlooked. For individuals who have changed their names, accurately listing all former names is critical for background checks and for linking any past records.
  3. Overlooking the option to update address details with the Child Care Division: The form provides an option to have one's address updated in the Central Background Registry records. Not checking this box or failing to provide the correct Registry number can lead to outdated contact information in official records.
  4. Incomplete racial/ethnic background information: In Section 2, individuals must choose the racial or ethnic group(s) they identify with or specify an 'Other' category. Skipping this section or not clearly listing a preferred choice can affect the inclusiveness and accuracy of demographic tracking.
  5. Not specifying language capabilities thoroughly: Questions regarding primary language and additional languages spoken are part of Section 2. Incomplete responses or failing to mention all languages spoken fluently can impact communication and potential job placements.
  6. Misunderstanding the workforce role: Section 3 asks for the individual's current position within the child care and education field. Mislabeling one’s role or leaving this section blank can misrepresent qualifications and experience.
  7. Assuming all sections apply: Sections such as Section 5, regarding childcare facility information, may not apply to all individuals (like those not currently working or volunteering with children). Mistakenly filling these sections or leaving them incompletely filled when they do apply can cause unnecessary confusion.

By addressing these common mistakes and ensuring that all sections of the form are correctly and completely filled out, individuals can streamline their enrollment process in the Oregon Registry Online system.

Documents used along the form

When engaging with the Oregon Registry Online Enrollment process, individuals often find themselves needing to prepare or gather several other documents to ensure a complete and compliant submission. These documents play a vital role in documenting qualifications, personal information, and compliance with regulations in the field of childhood care and education. The comprehensive approach to enrollment and documentation not only aides in professional development but also contributes to the broader goals of maintaining high standards within the childcare industry in Oregon.

  • Proof of Identity: A government-issued photo ID (such as a driver's license or passport) is required to verify the identity of the applicant. This ensures that the enrolled individual is the same as the person represented in any accompanying documents and credentials.
  • Certified Copies of Educational Credentials: Certificates, diplomas, degrees, or official transcripts that confirm the educational background of the applicant are often necessary. These documents support the level of education entered in the enrollment form.
  • First Aid and CPR Certifications: Copies of current First Aid and CPR certifications demonstrate that the applicant is prepared for emergencies, a crucial requirement for anyone working with children.
  • Background Check Authorization Form: This form authorizes the Oregon Office of Child Care to conduct background checks, ensuring the applicant meets the safety requirements to work in a childcare setting.
  • Professional References: Letters or forms that provide professional references can be required to attest to the applicant’s suitability and experience in the field of child care and education.
  • Health and Safety Training Documentation: Proof of completed training in health and safety protocols specific to child care, sometimes mandated by state regulations, supports the applicant's qualifications.

Together, these documents support the enrollment form by providing a comprehensive profile of the applicant's qualifications, legal compliance, and readiness to provide high-quality childcare services. This thorough approach is central to maintaining the integrity of the childhood care and education field in Oregon, aiming to ensure that all practitioners meet the necessary standards of quality and safety.

Similar forms

The Oregon Registry Online Enrollment form shares similarities with the Professional Development Record (PDR) forms often found in other sectors such as healthcare and education. Both forms serve as tools for tracking an individual's professional growth, qualifications, and continued learning endeavors over time. The PDR and the Oregon Registry Online Enrollment form are crucial for maintaining up-to-date records that can be presented for job applications, promotions, or compliance with regulatory bodies, thereby underscoring their role in professional advancement.

Another document similar to the Oregon Registry Online Enrollment form is the Employee Information Form used broadly across various industries. This form collects detailed personal and contact information from employees for administrative purposes, much like the Oregon Registry form collects individual information in its first section. However, the Employee Information Form is utilized within an employee's primary organization for human resources needs, contrasting with the Registry's broader objective of facilitating professional development tracking across the field of childhood care and education.

Likewise, the Volunteer Application Form mirrors the Oregon Registry Online Enrollment form in its collection of volunteer workforce data. The Volunteer Application Form is designed to gather information about an individual's qualifications, areas of interest, and availability to volunteer, which bears a resemblance to the Oregon form's aim of documenting professional roles within the early childhood education sector. Both forms play an essential role in matching individuals with suitable opportunities, be it for volunteer positions or professional development pathways in their respective fields.

The Background Check Authorization Form also shares commonalities with the Oregon Registry Enrollment form, especially in terms of facilitating background checks for individuals working with vulnerable populations. While the Background Check Authorization Form explicitly seeks consent to conduct a criminal history check, the Oregon Registry form includes an option for enrollees to update their address with the Child Care Division for background registry purposes. Both documents are instrumental in ensuring the safety and well-being of children and maintain high standards within the workforce.

Dos and Don'ts

Filling out the Oregon Registry Enrollment Form is an important step for professionals in the field of childhood care and education. Here are some tips on what you should and shouldn't do to ensure the process is smooth and accurate:

  • Do double-check your personal information for accuracy, including your name, date of birth, and contact information.
  • Do not rush through the form. Take your time to read each section carefully to avoid errors.
  • Do use a current email address that you check regularly. This will be important for receiving updates and communications.
  • Do not leave required fields blank. If a section does not apply to you, confirm if there’s an option such as "N/A" or "None" that you should select.
  • Do review the optional enrollment information section and consider providing this data, as it helps track success in inclusivity.
  • Do not forget to sign and date the form in Section 6. Your signature is required to process the enrollment.
  • Do provide complete information about your employment or volunteer work, including the name of the facility and your role.
  • Do not share sensitive information beyond what is requested on the form to protect your privacy.

By following these guidelines, you’ll help ensure that your enrollment form is complete and processed efficiently. Remember, this form is the first step in managing your professional development effectively through the Oregon Registry Online system.

Misconceptions

There are several misconceptions about the Oregon Registry Online (ORO) Enrollment form that need clarification:

  • Misconception 1: Enrollment in ORO automatically updates all personal information across other state departments. While the form does include a section that allows for the updating of an address for the Central Background Registry, it is important to understand that this update is specific to child care division records. Individuals are responsible for updating their personal information with other state departments or agencies separately.
  • Misconception 2: Providing information about racial/ethnic background, languages spoken, and workforce information is mandatory. Section 2 of the form clearly labels this information as optional. It is collected for the purpose of tracking the success of inclusivity among populations but is not a requirement for enrollment in the system.
  • Misconception 3: The Oregon Registry Online is only for individuals directly employed in child care facilities. The ORO system is designed to track professional development for a wide range of positions within the childhood care and education field. This includes volunteers, consultants, and individuals in administrative roles, not just those employed by child care centers or family child care providers.
  • Misconception 4: Only those working with licensed child care facilities need to enroll in ORO. While Section 5 of the form inquires about the licensure status of the facility and the capacity in which the individual works or volunteers, enrollment in the ORO system can benefit all professionals in the childhood care and education field. This includes those in unlicensed settings, as it serves as a tool for managing training and education records for personal professional development.

Understanding these misconceptions is important for accurately completing the enrollment form and effectively utilizing the Oregon Registry Online system for professional development tracking in childhood care and education.

Key takeaways

Filling out the Oregon Registry Enrollment form is a significant step for professionals in childhood care and education. It's important to understand the key takeaways of this process for a seamless experience. Here are some essential points.

  • The form enrolls individuals into the Oregon Registry Online system, a platform for tracking professional development.
  • Section 1 requires detailed personal information, including name, date of birth, contact details, and a unique Registry number for those already in the system.
  • Updating the address on file for the Central Background Registry is possible through this form by indicating the desire to do so and providing a current Registry number.
  • Optional demographic information is requested in Section 2 to support inclusivity and diversity tracking, but this section is not mandatory for completion.
  • In Section 3, detailed information about the individual's role in the childhood care and education workforce, including position and education level, is collected.
  • Employment or volunteer information specific to the childhood care facility, including the facility's type and licensure status, is gathered in Sections 4 and 5.
  • By signing the form, the applicant authorizes the Oregon Registry Online to manage their training and education records and allows for authorized disclosures as per legal and professional standards.

This process not only facilitates professional development tracking but also ensures that individuals in the childhood care and education field are recognized according to their qualifications and experience. It's essential to carefully fill out the form, providing accurate and up-to-date information, to make the most of the resources and opportunities offered by the Oregon Registry Online system.

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