Training Request Form School/Center Name Contact Name Phone Fax Address E-mail # of Staff Involved in Training Age of Children Area of Interest / Topic Requested Staff Experience Mostly New Staff Mostly Experienced Staff Mixture of New and Experienced Staff Staff Education CDA 2 Year Associate Degree 4 Year Degree Other Type of Program Head Start Early Head Start Preschool Private Preschool Family Child Care Military Child Care Corporate Child Care Other We want to provide quality training that exceeds your expectations! Please help us prepare by answering the following. What do you wish to gain from training? Hands-On-Learning Lecture A mix of Hands-On-Learning and Lecture Other Please list any specific questions or concerns that you want us to address Is there something we can add that will appeal to your group? How familiar are your teachers with our curriculum? Not Familiar Somewhat Familiar Familiar Have they used a curriculum before? Yes No If so, which one(s)? Please share any other information that will be helpful as we prepare to conduct your training.