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Workshop & Training Request
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Email
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Your email
Contact Name
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Your answer
Contact Phone Number
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Your answer
Organization Name
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Your answer
Type of Organization
Non-Profit
Healthcare Provider
Government Program
Religious Institution
Education Institution
Corporation
Other:
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What topic are you interested in?
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Understanding Intimate Partner Violence 101
Intimate Partner Violence 201
The Intersection of Gender-Based Violence and Substance Use
Trauma and the Brain/Body
Trauma Informed/Social Justice Informed Care
Spiritual Trauma & Religious Abuse
Serving LGBTQ+ Survivors
Other:
Who is the intended audience?
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Your answer
What is your proposed date? (at least three weeks out)
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DD
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YYYY
If the date is flexible, please list the time frame.
Your answer
What is your ideal length of time?
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Less than 1 Hour
1-2 Hours
2-3 Hours
3+ Hours
Other:
Expected number of attendees?
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Your answer
What will be the training location (exact address, room number, etc.)?
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Your answer
Do you have a budget for trainers?
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Yes
No
Unsure
If yes, please describe
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What prompted you to reach out?
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What is the current level of understanding on this topic with your group?
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Your answer
What will be the impact if this training is successful?
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Your answer
What are you hoping attendees with learn? Please list at least three key take-aways.
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Any additional information you'd like me to know.
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Any questions you have?
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Preferred method of follow up
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Phone
Email
Other:
A copy of your responses will be emailed to the address you provided.
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