Training and Event Request Form

Thank you for your interest in a training from the Northwest ADA Center. The Northwest ADA Center can provide trainings on a variety of topics, including:

Americans with Disabilities Act (General)
Employment (ADA Title I)
Public Accommodations/Business (ADA Title III)
Reasonable Accommodations
Service Animals
State and Local Government (ADA Title II)
Telecommunications (ADA Title IV)

To help us track and respond to your request as soon as possible, please complete the following form, which asks for details about your training needs and preferences.

First Name *

Last Name *

Position

Agency/Organization *

Email *

Phone *

Cell Phone *

Requested start date if known

Month

Day

Year

Requested end date if known

Month

Day

Year

Location of Training/Event (please be as specific as possible) *

Type of Event *

Length of Training/Event

Do you have a budget for this project? *

Yes

Not sure

Estimated Size of Audience

Audience Make Up (all that apply)

Continuing Education Credits/Letters of Attendance *

CRCC Credits

ACVREP Credits

Letters of Attendance

None

Reasonable Accommodation Requests (please write "N/A if no accommodations are needed) *

Other Comments/Questions (Please list any training needs or preferences not addressed above, including any specific questions or scenarios that you would like us to cover in the training.)

Leave this field blank