A.DolewskiJune2025EECodesModuleEoC - Early CHOICES: An Inclusion Initiative

LEGAL NAME OF PARTICIPANT (Last, First, Middle Initial)

Dolewski, Ashley

AFFIRMED NAME OF PARTICIPANT (if applicable) (Last, First, Middle Initial)

Dolewski, Ashley

TITLE OF PROFESSIONAL DEVELOPMENT

Determining Preschool Environment Codes Module

IEIN

976858

DATE(S) OF ACTIVITY

June 23, 2025

NAME OF APPROVED PROVIDER (Enter in ELIS)

Illinois State Board of Education

REGION, COUNTY, DISTRICT, TYPE (RCDT) CODE (form is invalid without a state-approved provider RCDT code)

651088965510000

NAME OF THIRD-PARTY PRESENTER/ORGANIZATION AUTHORIZED BY A STATE-APPROVED PROVIDER ABOVE (If used)

Early CHOICES

NAME OF PRESENTER(S) (Do not enter into ELIS)

Ann Kremer

NUMBER OF PROFESSIONAL DEVELOPMENT HOURS AWARDED

1.5 hours

IS THIS ACTIVITY A STATE-MANDATED TRAINING?

Yes

X No

If you answered “yes,” place a check mark next to the corresponding training listed on the chart below.

State-Mandate Training Checklist

Anaphylactic Reactions & Mgmt.

Asbestos Mgmt. & Abatement

Asthma Management

Automated External Defibrillator

Bloodborne Pathogens

Bullying Prevention*

Care of Students with Diabetes

Concussions & Head Injuries

Cultural Competency

Educator Ethics

Educator Evaluator

Mental Illness, Trauma, & Suicide

Non-Restaurant Food Handler

Nutrition Training (Civil Rights)

Nutrition Training (General)

Open Meetings Act (Board)

Open Meetings Act (Other)

Opioid Overdose

Pest Management Plan

Preventing and Responding to Child Sexual Abuse

Protections and Accommodations for Students (ADA)

Protections and Accommodations for Students (Homelessness)

Racism-Free Schools

Educator Evaluator (Board)

Ensuring Success in Schools

First Aid, Heimlich, & CPR*

Freedom of Information Act (FOIA)

Hazardous Materials Training

Health Conditions of Students

Health Conditions of Students (Life-Threatening Bleeding)

Identity Protection

Isolated Time Out/Restraint

Mandated Reporting of Child Abuse and Neglect

School Board Membership Leadership

School Bus Driver Training

School Student Records Act*

Sexual Harassment & Discrimination

Short-Term Sub Teacher Training

Social-Emotional Learning

SpEd Training for Personnel w/o License

SpEd Training for Qualified Interpreters

Student Discipline*

Title IX

Trauma-Informed Practices

Violence Prevention & Conflict Resolution*

* Optional training

Signature of Approved Provider’s Representative

September 24, 2025

Date

Signature of Participant Legal Name

Date

Signature of Participant Affirmed Name (if applicable)

Date

ISBE 77-21B (7/24)