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RBT 40-Hour Training Questionnaire
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What is Your Name?
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*
State
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--- Select a State ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illininois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachussetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
Washington
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Wisconsin
Wyoming
City
*
--- Select Choice ---
Apollo Beach
Aventura
Bal Harbour
Balm
Bay Harbor Islands
Biscayne Park
Brandon
Callaway
Coconut Creek
Coral Gables
Coral Springs
Cutler Bay
Dania Beach
Davie
Deerfield Beach
Doral
Dover
El Portal
Florida City
Fort Lauderdale
Gibsonton
Golden Beach
Hallandale Beach
Hialeah
Hialeah Gardens
Hillsboro Beach
Hollywood
Homestead
Indian Creek
Key Biscayne
Lauderdale Lakes
Lauderdale-By-The-Sea
Lauderhill
Lighthouse Point
Lithia
Lutz
Lynn Haven
Mango
Margate
Medley
Mexico Beach
Miami
Miami Beach
Miami Gardens
Miami Lakes
Miami Shores
Miami Springs
Miramar
North Bay Village
North Lauderdale
North Miami
North Miami Beach
Oakland Park
Odessa
Opa-Locka
Palmetto Bay
Panama City
Panama City Beach
Parker
Parkland
Pembroke Park
Pembroke Pines
Pinecrest
Plant City
Plantation
Pompano Beach
Riverview
Ruskin
Sea Ranch Lakes
Seffner
South Miami
Springfield
Sun City Center
Sunny Isles Beach
Sunrise
Surfside
Sweetwater
Tamarac
Tampa
Temple Terrace
Thonotosassa
Town 'N' Country
Valrico
Virginia Gardens
West Miami
West Park
Weston
Wilton Manors
Wimauma
City
*
Zip Code
What is your email?
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Do you speak, read, and write English?
*
Yes
No
What made you interested in Behavior Analysis?
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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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