Preschool Trainer Workshop Information Form (01-21-08)

1. Trainer Workshop Information Form

This form is to be completed by the trainers who have attended the TN State Improvement Grant (TN SIG) workshops. The purpose of this brief form is to collect information on trainings that you have conducted since March 2009. Please enter information for every training that you have conducted since March 2009. For example, if you have conducted 4 trainings since March 2009 then you'll have to complete four forms.

This information is crucial for the TNSIG not only to improve future training efforts but also to continue to receive federal support. Information entered in the database is confidential. Data will be reported only in aggregate form with no identifying information present. If you have any questions about this brief form, please email the TN SIG evaluator Chithra Perumal- cperu2@uky.edu or the preschool coordinator Alissa Ongie-ONGIE@mail.etsu.edu

1. Your name:

Your name:

2. Your E-mail ID:

Your E-mail ID:

3. Date of Training

	MM		DD		YYYY
Date	Date of Training Date Month	/	Day	/	Year

4. Please specify the content material of the training.

Please specify the content material of the training. Parent workshops/brochures

Autism

Preschool literacy

Infant toddler literacy

5. Please specify the preschool(s) that participated in the training.

Please specify the preschool(s) that participated in the training. 1
2
3
4
5

6. For questions 6-10, please enter the name, and contact information (e-mail address and/or phone number) of a key preschool staff member who helped you organize the training from each participating preschool.

Preschool# 1

For questions 6-10, please enter the name, and contact information (e-mail address and/or phone number) of a key preschool staff member who helped you organize the training from each participating preschool. Preschool# 1 Name of the staff member from preschool # 1
Phone number of the staff member from preschool # 1
Email ID of the staff member from preschool # 1

7. Preschool # 2

Preschool # 2 Name of the staff member from preschool # 2
Phone number of the staff member from preschool # 2
Email ID of the staff member from preschool # 2

8. Preschool # 3

Preschool # 3 Name of the staff member from preschool # 3
Phone number of the staff member from preschool # 3
Email ID of the staff member from preschool # 3

9. Preschool # 4

Preschool # 4 Name of the staff member from preschool # 4
Phone number of the staff member from preschool # 4
Email ID of the staff member from preschool # 4

10. Preschool # 5

Preschool # 5 Name of the staff member from preschool # 5
Phone number of the staff member from preschool # 5
Email ID of the staff member from preschool # 5

11. Approximate number of people who attended the training.

Approximate number of people who attended the training.

12. We would like to hear from you about the trainings. So please let us know if you have any questions/concerns/comments regarding the trainings (content, scheduling etc.)

We would like to hear from you about the trainings. So please let us know if you have any questions/concerns/comments regarding the trainings (content, scheduling etc.)