Midwestern Intermediate Unit IV Professional Development Request
Please complete this form if you are seeking professional development from the Special Education Training and Consultation Team.
Once the request is received someone will be in touch to confirm.
Please direct questions to Richael Fertig, 724-287-4156 or richael.fertig@miu4.org
Email address *
Name *
Your answer
Position *
Your answer
School District/Organization *
Your answer
Phone Number *
Your answer
Topic or Content of Training *
Your answer
Location of Training *
Your answer
Requested date(s) *
Your answer
Time Requested *
Please specify details of your intentions for this training/workshop: *
Your answer
Anticipated number of participants: *
Your answer
Please indicate who will be participating in this training(Check all that apply) *
Required
Please describe the training space and amenities available: *
Your answer
Will you be the point of contact on the day of the training? *
If not, please list a point of contact with their contact information.
Your answer
Have any MIU IV staff members been contacted directly about this training? *
If yes, please indicate who:
Your answer
Other information:
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of MIU4. Report Abuse - Terms of Service