Diversity-Informed Infant Mental Health Tenets Workshop Request Form
Please complete the following information if you are interested in hosting a Tenets workshop for your program/department/organization/company.

Please note that we ask for a minimum of *3-months* notice in advance of your desired workshop dates. We will do our best to respond to you within 2 weeks.

What is the name of your organization?
Your answer
Where is your organization located (city and state)?
Your answer
Where will the workshop take place (city and state)?
Your answer
Who can we contact about this request (name, email address, and phone number)?
Your answer
What is your organization's primary field (ie, early childhood, social work, etc)?
Your answer
What type of audience are you requesting the workshop for?
Have you attended a Tenets workshop in the past? If so, please indicate the location and approximate date.
Your answer
How did you learn about the Tenets?
Your answer
What is the approximate size of the group for the workshop?
Are you requesting a half-day or full-day workshop?
A half-day workshop is 3 instructional hours; a full-day workshop is 6 instructional hours.
Please list three possible dates for the workshop you are requesting. We schedule our workshops months in advance and will try to accommodate your request.
Your answer
Is your date flexible?
Please tell us in one or two sentences what your goals are in bringing a Tenets workshop to your program/department/organization/company.
Your answer
Tenets workshops require two facilitators who are paired in a way to reflect our commitment to diversity. Would you like to request a particular facilitator(s)? Please note we cannot fulfill all requests.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service