Services for Teens At Risk

Training Requests

STAR-Center Outreach Staff Development Request Information Sheet
Contact Person: Telephone#:
School District/Agency: Fax#:
Mailing Address: Address2
County: City:
Zip Code: E-Mail:
Please provide pager or home phone number for contact person in the event the presenter must reach someone at the last minute - especially important for out-of town presentations:
Please complete the following:
Service Requested:Date RequestedTime Requested
Full day inservice
If repeating, list all times
Anticipated # of participants:
Are you requesting a specific presenter?
If yes, please provide name of presenter.
(Please note that we cannot guarantee the availability of the presenter requested; but will make every effort to fill your request using available staff member.) Location of Training:
(Please provide complete mailing address and attach written directions and estimated driving time when returning this request.)
Topic Area to be Addressed:

STAR-Center does not request speaker's fees; however, we do ask that districts/agencies requesting presentations provide the following: Duplication of printed material for distribution the day of the training (we will provide a copy of these materials prior to the training); reimbursement of mileage at a rate of 55 cent/mile; reimbursement of airfare, overnight accommodations, ground transportation and meals, for locations requiring these arrangements.

Please check this box if you agree to the above terms:

Please enter the characters you see below: