.
	Regional Adult Education Network, EAST Registration Form 2004 Name Business Mailing Address Business City, State, Zip Name of Agency or Program Preferred Address to receive mailings from RAEN, Capital North. Click here if same as above Street Address City, State, Zip Position Subjects Employment Status   Administrative   Case Manager   Clerical   Consultant   Counselor   Data Entry   Family Educator   Managerial   NYSED Staff   Paraprofessional   Teacher   Technical Assistance Center        Trainer   Tutor Other:     Basic Education   Career and Life Skills   Citizen Preparation   Civics Education   Computer Instruction/Lab   ESOL/ELL   Family Literacy   GED   Math   Parenting Education   Workforce Development   Workplace Literacy Other:   ALIES   NRS   Consultant   Employed Full time   Employed Part time No. of years in position    Volunteer       Unpaid       Paid   Tutor       Unpaid       Paid   Trainer       Unpaid       Paid Certified?    Yes    No If yes, state certifying agent: Telephone Business Number: Optional Home Number: Mobile Number Fax Business Fax number: Optional Home Fax Number: Email Business E-mail: Work website address: Optional Personal Email: Preferred Times for Staff Development Offerings   Monday Tuesday Wednesday Thursday Friday Saturday 8:30 - 12:30 morning morning morning morning morning morning 12:30 - 4:30 afternoon afternoon afternoon afternoon afternoon afternoon 4:00 - 8:00 evening evening evening evening evening evening 9:00 - 4:00 all day all day all day all day all day all day Volunteer Opportunities(Please indicate if you are interested in any of the following)  Assisting with program registrations and facilities at training locations  Facilitating Forum Discussions – Indicate Subject or topic preferred   Serving as an Advisory Board Member  Training other professionals – Indicate area of interest   Working as a mentor – Indicate area of interest   Writing or securing articles for Newsletter  RAEN, Capital North funding provided through the State University of New York Research Foundation, University at Albany, School of Education and the New York State Department of Education, Office of Adult Education and Workforce Development, Workforce Investment Act, Title II funding.

This site best viewed with:   OR   Click one of the logos above to download a new web browser