Licensed Child Care Administrators Exam Registration Form Please notify our office at the time of registration for special assistance or accommodations. Questions? email profdev@uta.edu or call 817-272-3921 Name __________________________________________________________________ Address_________________________________________________________________ City________________________________ State _______ Zip_____________________ Agency _________________________________________________________________ Agency mailing address____________________________________________________ City ________________________________ State _______ Zip____________________ Home Phone ( Fax # ( ) ) Office Phone ( Cell Phone ( ) ) E-mail address LICENSED CHILD CARE ADMINISTRATORS EXAM Exam # ______________________________ Exam Site Exam Date Mail to: Professional Development Program UTA School of Social Work Box 19129 Arlington, TX 76019-0129