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UPLIFT Interest Form
Welcome to UPLIFT: A Trauma-Informed Training Program for Schools. Please complete the form below to help guide follow-up conversations with your Regional Trauma Coordinator (RTC). The answers provided are meant to assist your RTC with helping you identify UPLIFT training and/or consultation activities that enhance your current practices.
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* Indicates required question
Email
*
Your email
Which Regional Educational Service Center (RESC) serves your district/organization?
ACES (Region 5 - South Central)
CES (Region 6 - Southwestern)
CREC (Region 3 - Central)
EASTCONN (Region 2 - Northeastern)
EdAdvance (Region 1 - Northwestern)
LEARN (Region 4 - Southeastern)
I do not know
Clear selection
Primary Contact Name
*
Your answer
Title/Role
Your answer
Phone Number
*
Your answer
District/Organization
Your answer
School(s)/Departments
Your answer
How would you describe your system/organization?
Public school or district
Private, charter, or parochial school or district
RESC magnet or specialized program
Community-based social services organization
Town/Government-based organization or department
Community-based medical organization (e.g., primary care, hospital)
Post-Secondary (e.g., community college, university, etc.)
Other
Which grade level(s) do you work with? (Check all that apply)
*
PreK
Elementary
Middle School/Intermediate
High School (9-12)
Transition
Other
Required
Which option of engagement are you interested in? (Check all that apply)
Curious to learn more
Professional Development
Implementation at the school or district level
Train-the-Trainer
Other:
Has your school/district/agency received training in trauma-informed care previously?
Yes - at the district level
Yes - at the school/department level
No
Clear selection
Briefly describe your interest in UPLIFT, and how you think it may benefit your staff, families and/or those you serve. Please include any major social-emotional and/or behavioral health challenges you hope to address.
Your answer
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