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Howard County CCRC Onsite Training Request Form
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1.
Program Name:
(Required.)
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2.
Contact Person:
(Required.)
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3.
Address:
(Required.)
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4.
Phone:
(Required.)
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5.
Email:
(Required.)
6.
Training Site Information (please complete if different than above)
Name of Training Site:
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7.
Address:
(Required.)
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8.
Please give 3 possible dates that would work for your training: (Monday - Friday During the day 9-4pm, or Monday - Thursday Evening 6-9:30)
(Required.)
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9.
Expected Number of Participants
(Required.)
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10.
Desired Workshop Topics/ and or COK Area:
(Required.)
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11.
Additional Information: request for specific trainer, issues to address during training, goal of training, deadline for completion, etc.
(Required.)
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12.
Training Room Details: Is the room equipped with the following: Enough adult-sized chairs for all participants?
(Required.)
yes
no
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13.
Outlets for a laptop computer & projector?
(Required.)
yes
no
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14.
Projector screen or white wall for presentation?
(Required.)
yes
no
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15.
How did you hear about us? (Please select all that apply)
(Required.)
E-mail
Brochure
Word of Mouth
Website
Other
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