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Individual & Group Programming

Page One

1. Which programming or service option(s) would you like?
2. Contact Information
4. Information for the child/individual for which services are being requested:
This question requires a valid date format of MM/DD/YYYY.
calendar
Ethnic Information:
Is the child/individual emancipated? *This question is required.
5. Please indicate areas you are most concerned about for your child:
6. Please indicate your general preference for scheduling sessions. Scheduling will be based on trainer availability; however, we will make every effort to find a mutual fit in scheduling.
Space Cell MondayTuesdayWednesdayThursdayFriday
Morning (8:00 am - 12:00 pm EST)
Afternoon (12:00 pm - 5:00 pm EST)
7. How did you hear about this programming option?
Have you had previous training on the topic(s) for the event?
If yes, in what format was the training and who delivered the training?
Space Cell Presented by HANDSPresented by other group(s)
Manual or other written materials
Web (webinar, self-paced modules/webcasts)
Phone consultations on specific topics
Email consultations (group/individual) on specific topics
Partial day workshop
All day workshop
Multi-day training
Community-based coaching and mentoring
8. Optional: Would you want to join HANDS email list(s) to receive event updates, newsletters, as well as practical pointers via email? Check any/all subscriptions you would like to join.