Request Training

Name of Individual Requesting Training*
First Last
Agency*
Agency Address*
Street Address City
Phone*
Email*
Today's Date*
Date Format: MM slash DD slash YYYY
About the Training
Desired Topic for Training*
If this is a request for a ROMA training, when was the last time your agency staff attended a ROMA Training?
Preferred Date(s) of Training*
Expected Audience*
Please select the expected members of the audience. You can select more than one option.
- Board members
- Front line/direct service staff
- Executive level staff
- Program Managers
- Members of the Public
Expected Number of Participants*
Expected Duration*
What are the objectives for the training?*
What outcomes do you want to achieve as a result of the training?*
Special Requests or Instructions
Name
This field is for validation purposes and should be left unchanged.

About the Training