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RBT 40-Hour Training Questionnaire
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What is Your Name?
*
First
Last
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
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California
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District of Columbia
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Maryland
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Ohio
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Pennsylvania
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South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
What is your email?
*
Do you speak, read, and write English?
*
Yes
No
What made you interested in Behavior Analysis?
*
Do you know someone who has worked in the field of ABA?
*
Yes
No
Have you ever worked in taking care of children?
*
Have not worked with children
Babysitting
Taking care of children in a professional manner
Taking care of children in a professional manner with development disabilities
Do you have a valid driver's license?
*
Yes
No
What area are you based in?
*
How many credits are you currently taking?
*
13 or more credits
9 to 12 credits
6 to 9 credits
Below 6 credits
None
Do you have the ability to lift 50 pounds?
*
Yes
No
What is your phone number?
*
How did you hear about us?
*
Someone referred me
Internet
Social Media
Ads
Please Add Referees Name
*
Are you currently enrolled in college?
*
Yes
No
Which school are you attending?
*
What do you use your tablet or smart phone for?
*
Texting, email and social media
Texting, email and social media and note taking (Word & Excel)
Same as above but with Cloud Storage (iCloud, Dropbox, ShareFile, OneDrive)
Programming, virtual machines, continuous backups, graphic design
What hours are you available for training?
*
Mornings/Midday
Afternoons/ Evenings
Afterwork hours
Do you have reliable transportation?
*
Yes
No
Have you taken any ABA Courses? If so where?
*
Are you currently working at another job?
*
Working at another job for 20 hours or more
Working at another job between 10 to 20 hours
Working at another job for 10 hours or less
Currently unemployed
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