Training Schedule Request Survey

***Please be advised that this form must be submitted to the ELCNWF at least 45 days prior to the training event date.

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* 1. Today's Date:

The date this form is completed.

Date

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* 2. Trainer Name:

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* 3. Registry ID #

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* 4. Title of Training Event:
(Course Prefix if Applicable)

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* 5. Location of Training(complete address required):

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* 6. Start Date(s) of Training(s):

On what date the training is to start.

Date

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* 7. Start Time of Training(s):

What time the training is to start each day.

Time

AM/PM

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* 8. End Date(s) of Training(s):

On what date the training is to end.

Date

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* 9. End Time of Training(s):

What time the training is to end each day.

Time

AM/PM

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* 10. What is the cost per participant(Choose only one answer):

$5.00

$10.00

$20.00

$40.00

No Charge

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* 11. Min. # of participants:

The minimum number of participants for this training.

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* 12. Max. # of participants:

The maximum number of participants for this training

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* 13. Number of Training Hours:

All sessions must be a min. of 2 hours.

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* 14. Frequency of this event(Choose only one answer):

Non-enrollment event

One-time enrollment event

Once a Week

Twice a Week

Three Times a Week

Four Times a Week

Once a Month

Twice a Month

Three a Times Month

Four Times a Month

Quarterly

Once a Year

Twice a Year

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* 15. Describe event:

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* 16. Contact person for this event and contact information:

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* 17. Activity Category (Choose only one answer):

First Aid/CPR

Mentoring

Professional Development

Social Services

Early Childhood Education

Child Assessment

Program Improvement Process

Focus Group

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* 18. Activity Subject(Choose only one answer):

Parenting

Family Involvement

Reading/Literacy

Early Childhood Education

Health/Nutrition

Child Development

Community Involvement

Program Improvement Process

Focus Group

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* 19. Activity Target Group(Please choose all that apply.):

Directors

School Staff/Teachers

Family Child Care Home

Coalition Staff

Children

Families

Community/Neighborhood Residents

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* 1. Today's Date:

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* 2. Trainer Name:

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* 3. Registry ID #

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* 4. Title of Training Event:(Course Prefix if Applicable)

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* 5. Location of Training(complete address required):

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* 6. Start Date(s) of Training(s):

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* 7. Start Time of Training(s):

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* 8. End Date(s) of Training(s):

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* 9. End Time of Training(s):

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* 10. What is the cost per participant(Choose only one answer):

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* 11. Min. # of participants:

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* 12. Max. # of participants:

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* 13. Number of Training Hours:

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* 14. Frequency of this event(Choose only one answer):

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* 15. Describe event:

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* 16. Contact person for this event and contact information:

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* 17. Activity Category (Choose only one answer):

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* 18. Activity Subject(Choose only one answer):

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* 19. Activity Target Group(Please choose all that apply.):

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* 20. Activity Partners/Sponsors:

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* 21. Event ID#

* 4. Title of Training Event:
(Course Prefix if Applicable)