Request for Services

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REQUEST FOR SERVICES

Organization:*

Contact Name:*

Contact Title:*

Phone:*

Fax:

Email:*

Verify Email:*

Preferred Date:*

Alternate Dates:*

Time Frame:*

Location:*

Street Address:*

City:*

Zip Code:*

Follow up Dates:

Number of Participants:*

Audience:*

Professional Development Topics:
Cultural Responsiveness
Ruby Payne's "A Framework for Understanding Poverty" ® (Time required: 2 days)
Parent Empowerment - Train-the-Trainer (Time required: 1 day)

Parent Empowerment:

Self Esteem
Managing Behavior/Self-Discipline
Effective Parent/Teacher Conferences
Home Study Skills
Language Development
Knowledge is Power

How can the desired professional development be tailored to support your organization’s objectives?):*

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How do you plan to implement and follow-up after the training?:*

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What are additional services your organization would like offered?:

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