TELL US ABOUT YOURSELF

TELL US ABOUT YOURSELF

(Each trainer is required to fill out this section)

Name: _______________________________________________________________________

Title: ________________________________________________________________________

Credentials: ___________________________________________________________________

Organization/Agency: ___________________________________________________________

Address: ______________________________________________________________________

City: ______________________________ State: __________ Zip: _____________________

Phone: _____________________________ Fax : __________________________________

E-mail: _____________________________ Web Site: _______________________________

Do you represent a specific ethnic or cultural group, committee, or special interest group?

If so, please list:

_____________________________________________________________________________

RECENT TRAINING OR PRESENTATIONS DELIVERED

_____________________________________________________________________________

TITLE OF PROPOSED TRAINING
What is the title of your proposed training topic? Please type or print it as it would appear in the school catalog (Up to 10 words).

_____________________________________________________________________________

FORMAT OF PROPOSED TRAINING
Please indicate the format option for which this training is designed:

____ Major study track (20 hours)

____ Mini-track (6 hours)

WHAT IS THE DILEMMA, NEED, OR ISSUE THAT YOUR TRAINING

WILL ADDRESS?

______________________________________________________________________________

WHAT ARE THE LEARNING OBJECTIVES OF THIS TRAINING?

______________________________________________________________________________

AUDIOVISUAL NEEDS
Indicate what audiovisual equipment you (and any co-presenters) may require:

SUMMARY/ABSTRACT OF TRAINING

Title of Training:

Presenter(s):

Please type (up to 400 words):

______________________________________________________________________________

Print and complete this application and mail along with a current resume' to:

NCFADS
Training Proposals
P.O. Box 4024
Wilmington, NC 28406

910-799-6594