CDA Application Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress *Phone Number *Email *Date of Birth *Last four of social *Child Care Facility that Participant works at *Which Program are you applying for? *CCCCCDAAre you at least 18 years of age? *YesNoDo you hold a high school diploma? *YesNoDo you work for a child care center for at least 20 hours per week? *YesNoThird ChoiceWhich CDA are you looking to obtain? *Infant and Toddler CDAPreschool CDAFamily Child Care CDAHome Visitor CDAAre you applying for the Kids Now Scholarship? *YesNoWho is your CCA Professional Development Coach? *If we need to have multiple classes which day would you prefer?TuesdayThursdayHave you been approved the Kids Now Scholarship? *YesNoNot sureIf not, It is $500.00 for each 60 hours of credit. The total for the CDA program for ECCTC is $1,000.00. We have three payment options. Please choose which option best fits yours needs.Option 1: Pay full amount of $1,000.00 to ECCTC in full for the CDA courses.Option 2: Pay $500.00 for each 60 hours at the beginning of each semester.Option 3: Pay $200.00 at the beginning of the course and pay $20.00 per session. This will have to be automatic withdrawl to be eligible for this optionSubmit