Curcio Connects Event Request Form
Interested in having Michele Curcio visit your school or organization to provide professional development on Google Apps for Education? Please complete the form below and I will contact you as soon as possible. I can also be reached via email at mcurcio@curcioconnects.com.
Email address *
Name/Contact Person *
Your answer
School/District/Organization *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
How do you prefer to be contacted? *
Type of Service Requested *
Required
Topic/Details *
Please be as specific as possible.
Your answer
Audience/Participants *
Who is the target audience? (Admins, teachers, student teachers, etc.)
Your answer
Date of Event *
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DD
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YYYY
Are multiple sessions/days needed? If so, please add additional dates.
MM
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DD
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YYYY
Event Location *
Please include name of building/school, street address , city, state, and zip code. If there are multiple buildings or a campus, please provide any specific directions needed. ( Road access, parking, permits, etc.)
Your answer
Audience/Participants
Please share any information that may be relevant such as specific goals or audience backgrounds. For example, is this your district's first year implementing GAFE, using Google Classroom, or Chromebooks?
Your answer
Proposal Contact *
Please indicate the name, address, email, and phone number of the person to whom the proposal should be sent. If there is a deadline date for proposals, please indicate that as well.
Your answer
Billing Contact/Address
Please provide name and full address of person to whom an invoice should be sent and any specific requirements.
Your answer
Other information/questions
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