Continuing Education Documentation
STATEMENT OF SPECIFICS

1. List of Training Objectives:
   
2. Description of course content:
   
3. Description of teaching methods to be used in training
   
4. Statement of how this training acativity will advance or enhance the practice of Social Work, Education, etc.:
   
5. Instructor(s)
   
6. Email or forward a hard copy of the following:
   
   1. copy of handout materials used in training.
   2. resume or vita - paper format / vita - computer format, of instructor(s).
   3. copy of training outline or lesson plan.
   4. number of participants you are expecting
   5. What are the scheduled times for training?
      

      Date:		Time:	-
      Date:		Time:	-
      Date:		Time:	-
      Date:		Time:	-

   6. What Audio-Visual equipment will be needed from Head Start? (Note: Head Start does not guarantee we can honor your request.)
      

      	Overhead Projector
      	Screen
      	Flip Chart
      	TV/VCR
      	LED Projector
      	Laptop Computer
      	Slide Projector
      	Filmstrip Projector
      	Sound System
      	Other

   7. What training space or facility will be needed or used?
      
   8. Will help be needed for setting up or conducting training? Yes     No
      If yes, what help will you need?
      

   

   Please forward this information to Training along with other materials requested. You will be notified if CEUs can be given for this training activity, as well as availability of AV equipment and assistance if these are needed.

       

   Return to Training Page      Training Forms