Mariposa Training Application

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County of your child care program(Required)
How did you hear about this opportunity?(Required)

Name(Required)
Childcare Address(Required)
Your personal number
If you are selected to participate in this cohort, you are expected to attend all 13 training sessions. If selected, I agree to review the training schedule and ensure that I can commit to all sessions on Tuesdays at 6:30pm.
I am aware that If I am selected to participate in this cohort and receive a stipend, it will be considered taxable income and I will receive a 1099 form from Abilities Network at the end of the year for tax purposes
If you are selected to participate in this cohort, you must complete a W-9 form in order to receive the stipend.
Are you aware that frequent absences may result in stipend reductions, loss of stipend, or possible loss of COK certificate?