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Health Consultant Registration
Health Consultant Registration
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Professional Credentials
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RN
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MSN
NP
CPNP
CRNP
MD
DO
DDS/DMD
RD
RDH
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Primary Information
Primary means where you want ECELS to contact you
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State
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Alabama
Alaska
American Samoa
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Armed Forces Americas
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Utah
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Zip Code
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Phone
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Email
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Organization Information
Organization means where you work
Current Employer
Address
City
State
- select State/Province -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
United States Minor Outlying Islands
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Phone
Communication Preferences
You may contact me at my primary:
Email
Phone
Additional Preferences
What counties are you willing to work in?
Adams
Allegheny
Armstrong
Beaver
Bedford
Berks
Blair
Bradford
Bucks
Butler
Cambria
Cameron
Carbon
Centre
Chester
Clarion
Clearfield
Clinton
Columbia
Crawford
Cumberland
Dauphin
Delaware
Elk
Erie
Fayette
Forest
Franklin
Fulton
Greene
Huntingdon
Indiana
Jefferson
Juniata
Lackawanna
Lancaster
Lawrence
Lebanon
Lehigh
Luzerne
Lycoming
McKean
Mercer
Mifflin
Monroe
Montgomery
Montour
Northampton
Northumberland
Perry
Philadelphia
Pike
Potter
Schuylkill
Snyder
Somerset
Sullivan
Susquehanna
Tioga
Union
Venango
Warren
Washington
Wayne
Westmoreland
Wyoming
York
For multi-select: Hold "ctrl" and click to add or remove selections, use "command" on Mac.
Areas of Interest
Working with a specific early childhood education/child care program
Being available for telephone consultation to a child care provider
Providing health screening for children or staff in child care programs (please specify)
Teaching classes on health related topics for child care providers
Becoming a certified instructor for the AAP Pediatric First Aid Course (PedFACTS)
Writing articles for ECELS health & safety newsletter, HEALTH LINK Online
Serving as a consultant for a Head Start program
Working with child care programs to facilitate inclusion of children with special health care needs
Arranging routine health services for children in child care programs who lack care
Other
Who will you provide screenings for?
What subjects are you interested in writing on?
What other contributions would you be able to make?
Are you currently working with an early childhood education/child care program?
Yes
No
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