Please complete the form below. In order to prepare a Scope of Work, and be able to address your needs as soon as possible, please answer these questions to the best of your ability, thank you! First Name * Last Name * Position Agency/Organization * Email * Phone * Cell Phone Topics (check all that apply) * Americans with Disabilities Act (General) Accessible Parking Assistive Technology ADA Title I (Employment) ADA Title II (State & Local Government) ADA Title III (Public Accommodations) Disability Language & Etiquette Education Effective Communication Emergency Preparedness Healthcare Hospitality Housing Legal Resources Other Reasonable Accommodations Service Animals Telecommunications Transportation Veterans Requested Start Date (if known) Year Year20222023202420252026 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Requested End Date (if known) Year Year20222023202420252026 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Location of Training/Event (please be as specific as possible) * Type of Event/Training * In-Person Training Webinar/Presentation Video Webinar Presentation Train the trainer: How to do a Site Survey Teleconference Presentation Conference Presentation Conference/Event Vendor Length of Training/Event (# of hours, # of days, etc) Do you have a budget for this project? * Yes No Not Sure Estimated Size of Audience Audience Demographics (staff, public, etc.) * Will you need Continuing Education Credits or Letter(s) of Attendance? (check all that apply) * CRCC Letters of Attendance ACVREP None Reasonable Accommodation Requests (please write “N/A” if no accommodations are needed) * Other Comments/Questions Leave this field blank