SCHEDULE INFORMATION FORM
NAME OF ORGANIZATION:
TYPE:
Telephone:
Initial Contact:
Date and Time Requested:
Address:
Name of Contact At Facility:
E-Mail Address:
Time of Workshop:
Location & Directions to Workshop:
Time of Availabiltiy
WORKSHOP DETAILS
Parents:
Number of Participants:
Adults:
Teens:
Other:
Teachers or Youth Leaders:
Available: Equipment ( Check all available):
DVD
VCR
Power Point Equipment
Board and Markers
Screen
Overhead Projector
Flip Chart
Printer for Handout
Name of Individual In Charge of
Equipment::
Room Layout: ( i.e. Classroom, Auditorium, Social Hall)
FACILITATOR
Name:
Telephone:
Cell Phone:
Additional Information:
CO-FACILITATOR
Name:
Telephone:
Cell Phone:
Additional Information:
