Training Request Form

* Required

School / Center Name:*

Contact Name:*

Phone:*

Mailing Address:*

City:*

State:*

Zip code:*

E-mail:*

Fax:

Number of staff involved in training:*

Age of children:*

Area of Interest / Topic requested*

Staff Experience:*

Mostly New Staff

Mostly Experienced Staff

Mixture of New and Experienced Staff

Staff Education:*

CDA

2 Year Associate Degree

4 Year Degree

Other

Type of Program:*

We want to provide quality training that exceeds your expectations! Please help us prepare by answering the following:

What do you wish to gain from training?*

What style of training will meet your needs?*

Hands-On-Learning

Lecture

A mix of Hands-On-Learning and Lecture

Other

If other what type:

Please list any specific questions or concerns that you want us to address.*

Is there something we can add that will appeal to your group?*

How familiar are your teachers with our curriculum?*

Not Familiar

Somewhat Familiar

Familiar

Have they used a curriculum before?*

Yes

If so, which one(s)

Please share any other information that will be helpful as we prepare to conduct your training.