Training and Consulting (TaC):Request for Services
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Required
TaC Professional Development:
Request for Services
GENERAL SESSION INFORMATION
Date of Session
*
required
Must contain a date in MM/DD/YYYY format. Valid range: Jan 1, 1950 – Jan 1, 2030
Start Time:
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required
8:00 a.m.
8:30 a.m.
9:00 a.m.
9:30 a.m.
10:00 a.m.
10:30 a.m.
11:00 a.m.
11:30 a.m.
12:00 (noon)
12:30 p.m.
1:00 p.m.
1:30 p.m.
2:00 p.m.
2:30 p.m.
3:00 p.m.
3:30 p.m.
4:00 p.m.
4:30 p.m.
5:00 p.m.
5:30 p.m.
6:00 p.m.
6:30 p.m.
7:00 p.m.
End Time:
*
required
9:00 a.m.
9:30 a.m.
10:00 a.m.
10:30 a.m.
11:00 a.m.
11:30 a.m.
12:00 (noon)
12:30 p.m.
1:00 p.m.
1:30 p.m.
2:00 p.m.
2:30 p.m.
3:00 p.m.
3:30 p.m.
4:00 p.m.
4:30 p.m.
5:00 p.m.
5:30 p.m.
6:00 p.m.
6:30 p.m.
7:00 p.m.
Lunch Time:
*
required
11:00 a.m.
11:30 a.m.
12:00 (noon)
12:30 p.m.
1:00 p.m.
1:30 p.m.
2:00 p.m.
Session Address:
Session Location:
Building and Room
Requested Topic:
CSIU 16 Presenter Requested:
Colleen Epler-Ruths
Nich Gallinot
Gary Grozier
Kaitlyn Hock
Pam Inch
Michael Lord
Kim Meiss
Chris Mitcheltree
Emily Smith
Nadeen Swab
Jennifer Waltman
Type of Visit:
Face to Face
Virtual
Special Accommodations:
Yes
No
What identifiable needs will this session address?
DISTRICT/CHARTER INFORMATION
School District/Charter School:
*
required
Benton Area
Berwick Area
Bloomsburg Area
Central Columbia
Danville Area
Lewisburg Area
Line Mountain
Midd-West
Mifflinburg Area
Millville Area
Milton Area
Mount Carmel Area
Selinsgrove Area
Shamokin Area
Shikellamy
Southern Columbia Area
Warrior Run
Columbia-Montour Area Vocational-Technical School
Northumberland County Career and Technical Center
SUN Area Technical Institute
Other
Contact Name:
*
required
First Name
Last Name
Contact Title:
Contact Phone Number:
Contact Email Address:
*
required
School Building:
PARTICIPANTS
Grade Level(s) of Participants:
Number of Participants:
Rate the level of prior knowledge on the requested topic:
None
Limited
Significant: This is a follow-up.
If significant, describe prior professional development that they have had on this topic:
MATERIALS & RESOURCES:
School District will provide:
Handouts
Projector
SMART Board
Technology
White Board
WiFi Password
*Other
*If Other, Please explain.
Is this part of ATSI?:
Yes
No
Is this a Statement of Work Request?:
Yes
No
Submit