CIS Orientation Interest Survey

* Required

* First Name

* Last Name

* Email Address

* Confirm Email Address

Phone

* Phone Type:

Mailing Address

Country

Street

City

Region

Postal Code

Birthdate (for record matching purposes, only)

* Which services do you deliver/supervise within CIS? (Check all that apply)

Early Intervention

Early Childhood and Family Mental Health

Specialized Child Care

Strong Families Vermont Family Support Home Visiting

Strong Families Vermont Nurse Home Visiting

I work across all of CIS

* What is your role in CIS? (Check all that apply)

Direct service provider

Supervisor

Coordinator

Administrative Leader

* How many years have you worked in CIS?

Less than 2 years

2 to 5 years

5 to 10 years

10 years or more

* Which CIS online learning modules have you completed through the State’s learning management system, LINC? (Check all that apply)

CIS Orientation

CIS One Plan

CIS Early Intervention

None of the above

* Through this orientation to CIS, I hope to __________ (please enter your response directly, below).