Intended Audience |
General Education Teachers | Special Education Teachers | Administrators |
Paraprofessionals | Parents | Specialists |
Training Requested |
Name of Training: |
Training Date(s) Requested: |
Start Time(s) Requested: | End Time(s) Requested: | |
Approximate Number of Participants/Attendees: |
Level of Training/Knowledge in Subject Matter: Introductory Intermediate Advance |
Location of Training Facility |
LEA Office/Classroom: |
Local Education Agency (LEA): |
Available Training Facility Equipment (Please indicate training equipment our training staff will have access to.) |
WiFi / Internet Multi-Media Projector Handheld Mic Lapel Mic Extension Cord None |
Technology Contact Person (Please indicate contact information for technology on-site or tech staff.): |
Individual Requesting Training (Requestor's Name): |
Contact Phone for Requesting Individual: |
Email Address for Requesting Individual: |
Training Day(s) On-site Contact Person: |
Contact Phone for On-site Contact Person: |
What are the expected outcomes you hope to achieve as a result of this training? (Outcomes for Staff) |
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BY CHECKING THIS BOX, I AGREE AND CONFIRM THAT THE SIGNATURE I HAVE TYPED BELOW IS THE ELECTRONIC REPRESENTATION OF MY ORIGINAL, HANDWRITTEN SIGNATURE WHEN USED ON THIS DOCUMENT. I FURTHER UNDERSTAND THAT SIGNING THIS DOCUMENT USING MY ELECTRONIC SIGNATURE SHALL HAVE THE SAME LEGAL FORCE AND EFFECT AS THE ORIGINAL. |
I AGREE |
Email address you would like the confirmation sent to: |
Special Education Director / Site Administrator's Initials (Administrator's initials are a substitute for signature on this digital form) |
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Today's Date: |