Professional Training Agreement

Professional Training Agreement

This form must be approved by your director and IRPD prior to confirming training with outside agency. This planning document should be used for all targeted and intense technical assistance ....
What type of technical assistance is this?

A One time trainingType option 2Type option 3Type option 4
General Information
Name of HKNC Staff/Coordinator of Training
Date of Request
Title of Training (create a unique title including state and agency name)
Please be specific
Proposed Training Dates (this date should not be confirmed until the PTA is approved).
Will this training be advertised to the general public? If yes, you will need to fill out the Marketing Request Form and inform marketing: https://form.jotform.com/222803955031047. This should be submitted 3-months prior to the training event.

YesNo
Partner/s Information (name, title, agency, email, phone)
Training Format*

VirtualHybrid (Virtual and In-Person)In-Person (field)In-Person (HKNC)
Location of event, if in-person
Is this training part of a conference?

YesNo
What is the name of the conference?
*If this training is part of a conference then you must also fill out a Conference Request form. You need to submit the form to your supervisor and then to Deb Harlin for their approval.

You can download the form here: Conference Request Form
Total Length of Training
Are CEU's being provided? If yes, specify.
Training Goals and Learning Outcomes
Training Level

Awareness-Based TrainingKnowledge and Skills-Based TrainingIntensive Training
What is the goal of this training?
Refer to Sample Goals and Learning Outcome Resource on the Staff Learning Center
What are the anticipated learning outcomes?
Refer to the Sample Goals Learning Outcomes Resource on the Staff Learning Center
How does this training align the regional rep's goal and vision for their region .
Participant Information
Number of participants
Role of participants (i.e., VR counselor, administrator, interpreters)
What population do the participants serve? Please select all that apply

Deaf and Hard of HearingLow Vision and BlindDeafBlind with Additional DisabilitiesDeafBlind Working Age AdultDeafBlind Older AdultDeafBlind Transition Age YouthOther
Experience of participants:
Please note here if the participants have a strong background in working with a specific population (i.e., strong background working with Deaf and hard of hearing but do not have experience working with individuals with vision loss).
Specific needs or requests
Interpreting needs
Other accessibility needs
Additional Notes
Training Planning Information and Support
Requesting IRPD Support: if yes, please indicate the type of support that is needed? Please Note: IRPD cannot guarantee staff will be available to provide this support.

No support neededSupport identifying training materials (PPTs, resources)Support creating materials (PPTs, resources)Support with creating a more engaging training (i.e., discussion starters, activities, assignments)Co-TrainerOther
Additional Notes:
Description of Training
Requested Trainer/s
Materials Needed:
Evaluation

Post Quiz + Impact Evaluation (knowledge and skills-based trainings)Impact Evaluation (awareness & some knowledge/skills-based)Post Quiz + Follow Up Evaluation/Discussion (intensive training)Pre and Post Quiz (used when required to provide CEU's)
When completed, please include the links to your Evaluation and PowerPoint.
Note: You will receive the link to the final PowerPoint once it is vetted by IRPD
Training Costs
Will there be a fee for this training?

YesNo
Are there costs associated with this training (i.e., Interpreting, captions, travel, lodging, meals) if you select yes, you will be directed to specify who is paying what.

YesNo
Preparation Fee

Partner/s Agency Costs: Partner/s Agency Preparation Costs:
HKNC Costs: HKNC Preparation Costs
Notes: Preparation Notes
Training Fee:

Partner/s Agency Costs: Partner/s Agency Training Costs:
HKNC Costs: HKNC Training Costs
Notes: Training Notes
Lodging

Partner/s Agency Costs:   Partner/s Agency Lodging Costs:
HKNC Costs:   HKNC Lodging Costs
Notes:   Lodging Notes
Meals

Partner/s Agency Costs:   Partner/s Agency Meals Costs:
HKNC Costs:   HKNC Meals Costs
Notes:   Meals Notes
Travel

Partner/s Agency Costs:   Partner/s Agency Travel Costs:
HKNC Costs:   HKNC Travel Costs
Notes:   Travel Notes
Training Location

Partner/s Agency Costs:   Partner/s Agency Training Location Costs:
HKNC Costs:   HKNC Training Location Costs
Notes:   Training Location Notes
Interpreting

Partner/s Agency Costs:   Partner/s Agency Interpreting Costs:
HKNC Costs:   HKNC Interpreting Costs
Notes:   Interpreting Notes
Captioning

Partner/s Agency Costs: Partner/s Agency Captioning Costs:
HKNC Costs: HKNC Captioning Costs
Notes: Captioning Notes
A/V Equipment

Partner/s Agency Costs:   Partner/s Agency A/V Equipment Costs:
HKNC Costs:   HKNC A/V Equipment Costs
Notes:   A/V Equipment Notes
Materials

Partner/s Agency Costs:   Partner/s Agency Materials Costs:
HKNC Costs:   HKNC Materials Costs
Notes:   Materials Notes
Other

Partner/s Agency Costs:   Partner/s Agency Other Costs:
HKNC Costs:   HKNC Other Costs
Notes:   Other Notes
Additional Information/Notes
Total Training Costs for Partnering Agency
Total Training Costs for HKNC
PTA Signatures
Supervisor of HKNC Employee - Digital Signature and Date of Signature
Information, Research, and Professional Development - Digital Signature and Date of Signature
Partnering Agency Signatures

If there are any partnering agencies please download a copy of this form and send to them to sign.
Partnering Agency Signature (Please include your name and title):
Date of Signature:
Please check the box below in order to submit the form.*
Should be Empty:

Professional Training Agreement

General Information

Training Goals and Learning Outcomes

Participant Information

Training Planning Information and Support

Description of Training

Training Costs

Preparation Fee

Training Fee:

Lodging

Meals

Travel

Training Location

Interpreting

Captioning

A/V Equipment

Materials

Other

PTA Signatures

Partnering Agency Signatures