On Site Training Inquiry December 21, 2016 On Site Training Inquiry Request a quote for a training to be provided at your site. Complete information below. A representative from Project ACT will contact you. On Site training is based on availability. Name * Required First Last Name of Organization * Required Address of Organization * Required Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone * RequiredEmail * Required How did you hear about us? * RequiredPrevious clientReferred by previous clientMSDEFacebookWebsiteEmail List ServeStatewide Training CalendarOtherWhat age range does your program serve? (check all that apply) * Required 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.) * Required In-person - trainer comes to your program, trainer and participants must wear masks, participants must maintain social distance of 6 feet from trainer Virtual - training conducted over Zoom, each participant must be on their own device (laptop or tablet preferred) Please indicate that you understand the safety restrictions in place for in-person training listed below: * Required I understand the safety restrictions. - Masks are optional for participants and trainers. - All participants must complete a personal health inventory prior to the training, and can only participate if they have passed the screening. Do any of the training participants need accommodations? (e.g. hearing or visual impairments)Do you know which specific training you want to request? * Required 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 - must be mm/dd/yyyy format * Required MM slash DD slash YYYY Requested Training Time * Required : Hours Minutes AM/PM AM PM AM/PM Number of Expected Participants * RequiredA list of participant names and their email addresses will be required prior to the training. * Required I understand. Training Location Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please give training location if address differs from previous address given Do you want to request an additional training? * Required Yes No Only complete section if an additional training is being requested2nd Training Date - must be mm/dd/yyyy format MM slash DD slash YYYY 2nd Training Time : Hours Minutes AM/PM AM PM AM/PM 2nd Training Title Number of Expected ParticipantsSection BreakWe 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? Posted in Uncategorized