After you complete a Breathe training, please input the training details below and upload your sign-in/roster sheet.

We will send you your pre and post assessment reports once all the data has been submitted.

Reach out to justbreatheindiana@gmail.com if you need assistance.

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* 1. Name of Trainer Submitting the Sign-in Sheet

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* 2. Email:

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* 3. Name and Emails of Additional Trainers:

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* 4. Date of Breathe Training:

Date

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* 5. Name of organization trained:

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* 6. Counties trained:

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* 7. Training conducted:

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* 8. Format of the training:

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* 9. How many people attended your Breathe Training? (we realize this number may not match the number of training participants on the sign in sheet you upload below if for some reason not everyone signed in)

Please submit your sign-in sheet below. The sign in sheet template can be found here on the Breathe Website under Breathe Presentation Resources. Please BOLD yes or no text to indicate if the staff member would like to be signed up for the Breathe Newsletter.
Reminder: sign-in sheets submitted must use the designated Breathe sign-in sheet and should not be handwritten/scanned.

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* 10. Upload sign in sheet below:

DOC, DOCX file types only.
Choose File

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* 11. Is there anything else you need to tell us about this Breathe training?

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