24-25 Site Specific Request Form

Site Specific Request Form 24-25

All requests are subject to trainer availability. There must be at least 5 participants in attendance. All requests will be in person. Requests must be submitted at least a week before requested date of training.
Center Name*
Contact Person*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Preferred Date and Start Time of Training
Number of Hours Needed*
Training Title Requested*
List Number of Attendees*
Trainer Requested*

Eve TalleyAllison TalleyDana ComeauxLacy DevillierShaunda GuidrozJacqueline RichardJill LevineDenise DurbinTracy FlynnShatari HuntElizabeth BakiesRee SmithCourtney VincentOther
Reason For Requesting Training*

Site ImprovementArea of Improvement NeededNot Offered on the CalendarSessions on Calendar are FullOtherNew Center
Which Dimension Did Your Center Score Lowest in CLASS Infant*

Relational ClimateTeacher SensitivityFacilitated ExplorationEarly Language SupportMy center does not have infantsMy center is new and has not been observed
Which Dimension Did Your Center Score Lowest in CLASS Toddler*

Positive ClimateNegative ClimateTeacher SensitivityRegard for Child PerspectivesBehavior GuidanceFacilitation of Learning and DevelopmentQuality of FeedbackLanguage ModelingMy center does not have toddlersMy center is new and has not been observed
Which Dimension Did Your Center Score Lowest in CLASS PREK*

Positive ClimateNegative ClimateTeacher SensitivityRegard for Student PerspectivesBehavior ManagementProductivityInstructional Learning FormatsConcept DevelopmentQuality of FeedbackLanguage ModelingMy center does not have Pre KMy center is new and has not been observed
Any Other Information?

Facility Information

Please provide information about your facility below.
We strongly encourage centers to allow participants from other centers to register for classes being held at their center, in order to ensure everyone has the opportunity to participate and get the clock hours needed. Are you willing to open your center to other providers?

YesNo
Please check all items that your facility has available.

Wi-fiAdult table and chairsSmart BoardWall suitable for projecting
Number of adults my center can seat comfortably.
I understand that there must be at least 5 participants (type III or FHP) in attendance for the training to take place.

YesNo
I understand that the training is not scheduled until I receive the registration link to register my staff for the trainings. I also, understand that is my responsibility to register my staff within three days of receiving the registration links.

YesNo

For Office Use:
Should be Empty: