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* 1. Name

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* 3. Phone Number

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* 4. Agency/Organization Name

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* 5. Which grant do you work with? (Select all that apply)

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* 6. Which county/reservation do you work with?

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* 7. Have you taken the Pre-SAPST course?

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* 8. I understand that I am responsible for making my own travel/hotel arrangements, if applicable, to attend this training.

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* 9. Please list any ADA accommodations you may need during the meeting (i.e. wheelchair accessibility, interpreter, special setting, etc.) All meals are the responsibility of the participant, it is not necessary to list special meal accommodations. Please put NA if not applicable.

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* 10. I understand that SAPST is free to Block Grant, PFS and CTC coordinators funded through BHDD.
There is a fee of $125 to cover materials for those not covered under the grants above.

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* 11. Cancellation Policy: If I need to cancel, I will do as soon as possible, but no later than, Monday, April April 22nd, 2024 so that my spot may be opened for someone else. If I need to cancel I will email barbara@youthconnectionscoalition.org.

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