SRCAC Custom Training and Conference Presentation/Workshop Application

If you are interested in an SRCAC trainer either delivering a custom training on-site or would like a trainer to deliver a presentation/workshop at your conference, please complete the following application. If you have any questions about this application, please contact Caroline Rossi at crossi@nationalcac.org.

Contact Information

First Name

Last Name:

Title

Organization/CAC Name

Street

City

State

Zip / Postal Code

Email

Phone

Organization/Agency Website

What type of training are you interested in having one of our trainers provide for you? Please choose one. If you aren't sure which one applies to your needs, please contact Caroline Rossi at crossi@nationalcac.org.

Custom training.Conference presentation/workshop.

Custom Training Information

Tell us about the type of training you are interested in and what you hope to achieve.

1. On what topic(s) are you interested in having SRCAC deliver a custom training?

Multidisciplinary teams (MDTs)Strategic planning/board developmentImpacts of vicarious trauma on individuals and organizationsDynamics of Personality, Interaction Styles, and Essential Motivators

2. What do you hope to accomplish with this training?

3. Why have you identified this particular issue as a need for custom training? Is this the result of a particular incident, requests for professional development opportunities, part of long-range training plan, etc.?

4. After the training is completed, how will you know that it was successful? What will success look like?

5. Have you contacted your state chapter about receiving support or training around this topic? If so, what was the outcome?

6. Approximately how many people will be attending this training?

7. How much time are you able to commit to this training? How long do you expect it to last?

8. Would you prefer this training be virtual or in person? (note that currently the Department of Justice is limiting travel for training due to ongoing COVID-19 concerns)

9. What is your ideal timeframe for this training to be delivered?

3-6 months6-9 months

10. Has SRCAC previously delivered training for your organization or MDT?

YesNoI'm not sure.

If "Yes," do you know when? What was the topic?

Conference Presentation/Workshop Information

1. What is the name of the conference where you would like our trainer to present?

2. Is this conference sponsored by the State Chapter?

YesNo

2. Location of conference (city/state)?

3. Dates of conference?

4. Will this conference be held virtually or in person? (note that currently the Department of Justice is limiting travel for training due to ongoing COVID-19 concerns)

5. Who is the intended audience for this conference?

6. SRCAC trainers can deliver presentations/workshops on the following topics. Please check the topic(s) that you would be interested in.

Multidisciplinary teams (MDTs)The CAC modelCAC staff-related topicsBoards of directorsImpacts of vicarious trauma on individuals and organizationsInteraction/Communication Styles, Essential Motivators and Cognitive Dynamics of PersonalitySpecial topics. Please see below.

If you selected "special topics," can you provide a brief explanation of the topic(s) you are interested in?

For SRCAC Use Only

Status of Request

Assigned to

Date Assigned

Contact Information