Building Relationships in Youth Programs Workshop 1.27.17

REGISTRATION

Questions? Call 641-421-2708

Question Title

* 1. Address

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 2. Today's Date

Date / Time

Date

Question Title

* 3. Do you plan to survey youth for the assessment component of this workshop?

Yes

No

Comments

Question Title

* 4. If you are surveying youth in your program, select the administration option below you would like to use:

NA-Not surveying youth

On-line surveys

Word document surveys

Comments

Question Title

* 5. Is your youth program operating with funding from the IDPH YSAPS Grant or a DFC Grant?

Yes-IDPH YSAPS-YD

Yes-IDPH YSAPS-PTM

DFC

Youth program not funded by any of the above

Other (please specify)

Question Title

* 6. If you are surveying program youth and have registered by Nov. 3, we will be in touch with further information shortly. We want to allow the months of Nov. and Dec. for you to administer the youth surveys.
If you are not surveying youth, we will be sending out reminders and workshop materials in January.
Do you have any questions or comments at this time?