Workshop and Training Request Form
Thank you for taking time to request Smith Curriculum and Consulting to provide a workshop to teachers that you care about!
* Required
First and Last Name
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Your answer
Email Address
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Your answer
City, State
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Your answer
Phone Number
Your answer
Employer (or Company requesting workshop/training)
*
Your answer
Location of Workshop/Training?
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Your answer
Please check the box(es) that describe your audience.
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Grades K-3
Grades 3-5
Grades 6-8
Grades 9-12
Pre-Service Teachers
Teachers
School/District Administrators
Other School Staff
Other:
Required
Is there any relevant information about your target audience that is pertinent to this workshop/training?
Your answer
Please select the workshop/training that you are requesting.
*
More information can be found at
http://www.SmithCurriculumConsulting.com/workshops
Choose
NEW! Implementing Response to Intervention in the Math Class (Full or Half)
NEW! Math Workshop: Getting Started and Making it Work! (Full Day only)
NEW! Number Talks in the Secondary Classroom (Full or Half)
Math with a Purpose: Making Students Think
Engaging Minds While Raising Achievement with Interactive Notebooks (INBs 101)
Practical Problem Solving
Differentiation Matters in Upper Elementary
Differentiation Matters in Middle School
Custom Created Workshop/Training
Combination of 2 or more
Preferred Date
MM
/
DD
/
YYYY
Preferred Time
Please note that many workshops can be given in 3 or 6 hour windows.
Time
:
AM
PM
Length of workshop requested
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Half Day (3 hours)
Full Day (6-7 hours including lunch break)
Multiple Days
Other:
Alternative Date
MM
/
DD
/
YYYY
How many participants do you expect per workshop/training session?
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Your answer
Is there any other information you think that needs to be know about your requested workshop/training?
Your answer
Do you understand that there will be a daily rate as well as travel expenses charged for all Smith Curriculum Consulting Workshops and a purchase order must be received no less than 2 weeks prior to the workshop?
*
An official quote will be sent once a request is made. Once a purchase order is received from the school travel will be scheduled. All travel needs to be scheduled at least 2 weeks prior to the workshop date so please plan accordingly. Travel scheduled less than 2 weeks prior to the workshop date will possibly adjust your quote.
Yes, I understand
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