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Workshop Request Form
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* Indicates required question
What is the name of your school district?
*
Your answer
Your Name + Job Title
*
Your answer
Your Email + Phone Number
*
Your answer
An Alternate Email (some school network firewalls may block my email from being received)
*
Your answer
School Name + Address
*
Your answer
School Phone Number + Website
*
Your answer
School Grade Level
*
Elementary
Middle
High
What workshop topic are you interested in?
*
Your answer
What month(s) are you looking to book this workshop?
*
January
February
March
April
May
June
July
August
September
October
November
December
Number of Workshop Participants Anticipated
*
Your answer
Estimated Budget for Professional Development
*
$3,000 - $5,000
$5,000 +
Required
Do you have any questions or comments for us?
Your answer
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