On Site Training Inquiry - Abilities Network Project ACT

Name *

First Last

Name of Organization *

Child Care Program License Number (if not a child care program, put N/A) *

Find your license number at www.checkccmd.org

Address of Organization *

Street Address Address Line 2 City State ZIP Code

Phone *

Email *

How did you hear about us? *

What age range does your program serve? (check all that apply) *

Select All
0-1 year olds
1-2 year olds
2-3 year olds
3-4 year olds
4-5 year olds
School-Age

What is your preferred training delivery method? (Project ACT cannot guarantee a specific delivery model at this time but will work to meet each program's needs.) *

In-person - trainer comes to your program
Virtual - training conducted over Zoom, each participant must be on their own device (laptop or tablet preferred)

Do any of the training participants need accommodations? (e.g. hearing or visual impairments)

Do you know which specific training you want to request? *

Yes
No

Click here to browse our available training topics.

Tell us about your group's training needs so that we can help you choose the right topic:

Training Title

Requested Training Date *

Requested Training Time *

:

Number of Expected Participants *

A list of participant names and their email addresses will be required prior to the training. *

I understand.

Training Location

Street Address Address Line 2 City State ZIP Code

Please give training location if address differs from previous address given

Do you want to request an additional training? *

Yes
No

Only complete section if an additional training is being requested

2nd Training Date

2nd Training Time

:

2nd Training Title

Number of Expected Participants

Section Break

We will be in touch with you to provide you with a quote and answer any questions you may have. What is the best way to contact you?

Email is best.
I'd prefer a phone call.
Either email or a phone call.

What is the best day to reach you? (select all that apply)

Monday
Tuesday
Wednesday
Thursday
Friday

What is the best time to reach you? (check all that apply)

9am-11am
11am-1pm
1pm-3pm
3pm-5pm

Is there anything else you'd like us to know about your training needs before we contact you?