Nebraska Early Childhood Professional Record System

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*

Organization, (if Other)

Age of children served in the program*

Infants

Toddlers

Preschoolers

Kindergartners

Primary School Age

Work Phone Number*

(e.g. xxx-xxx-xxxx)

Home Phone Number*

(e.g. xxx-xxx-xxxx)

Email*

(e.g. john.smith@example.com)

Address

Street Address 1*

Street Address 2

City*

State*

Zip Code*

Contact the Early Childhood Training Center
Email: nde.ectc@nebraska.gov
Phone: (402) 557-6880

Contact the Early Learning Connection for your area

For persons that need assistance, or are not able to utilize a computer to complete a NECPRS professional record, please call 844-807-5712.