Please answer the questions below and we will contact you to set up your training. Thanks

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* 1. Please provide your contact Information so we can follow up with you

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* 2. What is the location of the training?

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* 3. Please provide possible dates and times that would work for you.

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* 4. How many participants do you need trained?

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* 5. How would you classify the participants in your group?

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* 6. What school district will participants be screening in?

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* 7. What type of school will participants be screening in?

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* 8. How many of these participants received PBNC certification in the past two years?

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* 9. How many of these participants have never received PBNC certification?

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* 10. How many children will the screeners be screening? Note: PBNC is accountable for ensuring that certified screeners conduct mass screening (approximately 80 to 100 children screened annually per certified screener). For all screening groups, we must collect vision screening data in January and June to report outcomes.

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* 11. Can PBNC offer this training to additional participants who request training in your region? PBNC has a maximum of 30 participants per class

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* 12. Do you have any other comments, questions, or concerns?

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