Dear Presenter, thank you for taking the time to complete this form. The rest of the form will be completed by STAR NET. Please save a copy of this document for your records and email a completed copy of this document to your contact person so they can complete the remaining sections.
To Be Completed by Resource Specialist: Continuing Education Information
To Be Completed by Resource Specialist: Continuing Education Information (50-100 words)?
Workshop Fee: Free unless noted here. Workshops are held in the English language.
To be completed by STAR NET: Collaboration Information
(If this is in collaboration with the ECC, please use their collaboration form.
If the collaboration does not involve the ECC, please use this form.)
Secure and Payment of Location (AV requirements, location arrangement/set-up, guaranteed number shared with location)
Other handouts (Such as regional information)
Number of participants/agency
Give-Aways for ea. participant
AGENCY COLLABORATION WORKSHEET
Form is to be completed by ECC and shared with collaborating agency upon completion. All fields to be completed.
Presenter Contact (Includes obtaining the following information: preferred room arrangement/set-up (e.g., rounds; 2 display tables along wall), agenda, required A/V, will presenter require sleeping room the night before, handout original to be copied)
Location (Includes securing the following: A/V requirements with location or the person supplying, room arrangement/set-up requested, food order placed with location or outside caterer, guaranteed number shared with location)
Secure Virtual Room (for webinars)
Facilitator (provide lunch for presenter)
Handouts (include all collaborators on the handout folders including the logo for each agency)
Provide Required Paperwork to workshop (sign-in sheet, CPDU forms, evaluation forms, printed name tags)
STAR NET Staff should complete this form only if the workshop is a WBR.
(If taking registration in database participants’ name will appear on certificates, Registration forms will need to be distributed and submitted to star net.)
(If sign in sheet is provided, participants names will not appear on certificate and will not be entered into database)
(If certificates are provided, training will automatically be submitted for SLP credit and add to list to send for IDFPR credit.)
If providing certificates is there a collaborator that needs to be listed on the certificate?
if you want to take door prizes and/or a give-a-way for each person in attendance, please indicate what you would like the support staff to gather for you:
Please indicate what other materials you want and if they should be in the folders or not. If nothing is checked in a row, then that item is not needed.