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Home
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Trainings & Events
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Training and Technical Assistance Services
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Training Application
Training Application
Please submit this form at least 2 months prior to your desired training date.
Tailored Training Application Form
Contact First Name
*
Contact Last Name
*
Title
*
Organization
*
Address 1
*
Address 2
City
*
State
*
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Zip
*
Phone Number
*
Fax
Email Address
*
<p><strong>Contact Information</strong></p>
How do you prefer to be contacted?
Phone
Fax
Email
<p><strong>Workshop Information</strong></p>
Are you selecting a workshop from SHIFT NC's list of available trainings?
*
Yes
No
If you checked yes, please specify the training:
If you checked no, what would you like the focus of the training to be?
Preferred date and time
*
Please be specific about your requested time.
Alternate date and time
*
Please be specific about your requested time.
Training location
*
Please include location specifics, as well as city and county.
Target audience
*
Please tell us as much as possible about the target audience.
Is pre-registration required?
*
Yes
No
If yes, registrar's name
Registrar's phone
Registrar's email
Is your workshop open to others?
If your workshop to others outside of your organization, we can create an online registration page.
Yes
No
Estimated number of participants
*
Maximum room capacity
<p><strong>Shipping Information (For Materials)</strong></p>
ATTN:
Shipping Address