DDTI

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Training Request Form

For North Carolina Personnel and Families
(if any questions email Chris Egan)

Please read this form carefully, it has been changed.

**Contact Information**
Agency:
Person to Contact:
Address
City:
State:
Zip:
Office Phone:
Cell Phone
Email Address:
Retype Email Address:

Please check the training(s) your agency needs.

Models of Training Available for professionals and paraprofessionals whose primary focus is developmental disabilities
Person Centered Thinking (1 day, 30 trainees)	Essential Lifestyle Planning Person Centered Planning (3 days, Day 1: 30 trainees, Day 2 & 3: 18 trainees)
Targeted Case Management (1 day, 45 trainees)	Planning with Personal Outcome and Individualized Support Measures (3 days, Day 1: 30 trainees, Day 2 & 3: 18 trainees)
CAP MR/DD Waiver Services (1 day, 45 trainees)	Circle of Friends Using MAPS (3 days, 12 -15 trainees)
Crisis Planning and Management (1 day, 45 trainees)	PATH (Planning Alternative Tomorrows with Hope) (3 days, 20 Trainees)
	Other (Specify)

If you only have a couple of individuals who need a training, please check our online training registration page (insert link here) to check available dates and locations.

What your agency will provide:	What DDTI will provide:
a primary contact (to help us with local coordination) suitable* training space copying handout materials providing equipment (LCD projector and computer/laptop)	Trainer Original handouts to be copied certificate for each registered and paid participant

To Do Checklist

We have trainees who will benefit and can attend.
We have listed (above) a local contact in our agency. Please make contact.
We have identified a local training room and it is suitable* for the number of trainees.

*Suitable Training Room

A suitable training room should have the following features:

Large enough for the number of trainees for the given training model.
Comfortable seating and table space for taking notes.
Has area for trainer to present and space for AV equipment.
Has wall space on which news print sheets can be placed.
Has space for a break set-up for trainees.
Is free of excessive noise and interruptions.

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The University of North Carolina at Chapel Hill Maintains a Policy of Equal Educational Opportunity

Page last updated February 19, 2007