Nebraska Early Childhood Professional Record System Logo

Independent Study Form for Approval of Training Hours - Part 1

Note: * indicates required fields

I have read the Guidance in Selecting Materials for Independent Study document*

I have read and agree to the Terms and Conditions document*

First Name*
Last Name*
Previous Names Used
Maiden Name, Nickname
Child Care License Number
Organization, (if Other)
Age of children served in the program*

Work Phone Number*  (e.g. xxx-xxx-xxxx)
Home Phone Number*  (e.g. xxx-xxx-xxxx)
Email*  (e.g.
Street Address 1*
Street Address 2
City*            State*          Zip Code*     
NDE Logo
Copyright © NDE. All rights reserved. For persons that need assistance, or are not able to utilize a computer to complete a NECPRS professional record, please call 844-807-5712.