March 19, 2020 Trauma Informed Readiness and Response Planning Workshop Application

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* 1. Name of School (please include school level i.e. High School/Middle etc.):

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* 2. School District:

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* 3. Primary Contact (person with whom all communication and arrangements go through):

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* 4. Primary Contact Phone

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* 5. Primary Contact Email address

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* 6. Please list the 3 Team Members and their roles at the school (school level not district level please). Note that a minimum and maximum of 3 people are required for the activities planned, this includes the primary contact who should be listed again:

Participant 1 - First Name

Participant 1 - Last Name

Participant 1 - Role

Participant 1 - Email Address

Participant 2 - First Name

Participant 2 - Last Name

Participant 2 - Role

Participant 2 - Email Address

Participant 3 - First Name

Participant 3 -Last Name

Participant 3 - Role

Participant 3 - Email Address

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* 7. Describe the top three areas of need for your school around this topic, and why work on a responsive plan will help you overcome these.

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* 8. The agenda assumes familiarity of basic topic definitions, what work has your school done around this topic to date?

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* 9. How many substitutes will be required for the planned attendees and what is the anticipated mileage (used for our reimbursement planning only):

Number of Substitutes:

Cost Per Substitutes:

Anticipated total team mileage to be submitted for reimbursement (in miles not cost):