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* 1. Your name

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* 2. Your preferred email address

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* 3. Your professional title/role

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* 4. Which of these is your primary work environment?

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* 5. Name of your primary work environment (eg, name of school, SBHC)

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* 6. Name of school district

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* 7. Zip code in which you work

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* 8. We will use your answers to the next few questions to help determine the dates and times for the three spring trainings.

Please indicate your preferences related to the month in which the training is held.

  Preferred Neutral Not available
January
February
March
April
May

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* 9. Please indicate your preferences for the time of day in which the training is held.

  Preferred Neutral Not Available
Morning
Afternon
Evening

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* 10. Please indicate your preferences for the day of the week on which the training is held.

  Preferred Neutral Not available
Monday
Tuesday
Wednesday
Thursday
Friday

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* 11. What would you like to learn from this opportunity?

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* 12. How did you hear about this training?

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