Request Trainings2016-07-04T15:48:36+00:00
REQUEST A TRAINING
Please allow 2 weeks for BreakOUT! staff to contact you to discuss your request. While we do our best to honor each request, BreakOUT! cannot guarantee that we will be available to provide each training.
* Required
Name of Your Agency or Organization
Your answer
Contact Name
Your answer
Position/ Title
Your answer
Phone Number
Your answer
Email
Your answer
The primary audience being trained will be... *
Approximately many people do you expect to attend this workshop?
Groups of more than 20 participants may be broken into separate trainings.
Your answer
Will a supervisor or administrator be able to attend all trainings? *
BreakOUT! requires that someone with authority on policy & procedure be present at all trainings.
Required
Location of Workshop
(We are only able to offer workshops in the New Orleans area and surrounding parishes at this time. However, our space is available for some workshops and can accommodate approximately 20 people.)
Your answer
Scheduling Preference
Please choose your first option. We will do our best to accommodate your schedule! Please be mindful that longer trainings may require additional preparation time from BreakOUT! staff and may not be able to be scheduled immediately.
MM
/
DD
/
YYYY
Time
:
AM
PM
Alternate 1
Please choose an alternative date/ time.
MM
/
DD
/
YYYY
Time
:
AM
PM
Alternate 2
Please choose another alternative date/ time.
MM
/
DD
/
YYYY
Time
:
AM
PM
Tell us a little more about your agency needs, interests, and any particular issues your agency might be facing or need assistance navigating.
Your answer
Does your agency/ organization have an LGBTQ policy or non-discrimination policy that includes gender identity, gender expression, and/or sexual orientation?
If not, will your agency be willing to work with BreakOUT! staff and trainers to adopt an LGBTQ policy prior to the training?
Please tell us your agency's commitment to incorporating materials provided in workshop into your organizational culture or practices. How do you plan to implement recommendations or best practices from the training?
Your answer
What is your agency's budget?
Trainings are usually offered on sliding scale of 0.1% of an agency's budget. Discounted trainings available for public defender offices or smaller organizations.
Will your agency be interested in ongoing technical assistance or support longer than 1 month following the training?
Additional technical services and support is available to your agency free of charge for 1 month following the training. Additional assistance in implementing policy, troubleshooting issues, or in-person meetings may be provided to the agency at additional rates.
Submit
Never submit passwords through Google Forms.
This form was created inside of BreakOUT!.
https://www.gstatic.com/_/freebird/_/js/k=freebird.v.en.NKDQEZVNcfw.O/rt=j/d=1/rs=AMjVe6j-lylNFsb0E39gryXt-qI9OmoRDg/m=viewer_base