Training Request Form

Contact Name:

Email:

School/System:

Street Address:

City:

State:

Zip:

Phone (Voice):
(xxx-xxx-xxxx)

Phone (TTY):

Phone (toll free):

Number
of Participants:

Location
of Training:

Room Setup:

Tables are recommended for CAPE training for small group activities
Examples- u-shaped setup, setup in rows, setup in a square, auditorium room, etc...

Date(s) of Training:
(mm/dd/yy)

Time:

Please list the specific hours of the day, and make sure to use the date format indicated.

Focus of Training:

Curriculum & Contents for Sexual Abuse

Prevention in Educational Programs for the Deaf

History and Background of Abuse in Schools for the Deaf

Creating an Abuse-Free Environment

Breaking the Code of Silence

Human Sexuality Development