Primary Contact Name *
Position/Title *
Name of Organizing Group (Department / Faculty / School / Organization / Club) *
Phone Number *
Email Address *
Preferred method of contact * Phone Email
What type of workshop / training are you interested in?
Identifying and Responding to Students in Distress During Physical Distancing
Creating a Customized Self-Care Plan During Physical Distancing
LivingWorks START
How to be Physically Active during Physical Distancing
Other Workshop Requests (please describe)
Any other comments to add for the facilitator to know about?
(NOTE: all of our training sessions are currently offered online via Zoom)
1st Possible Date Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2021 2022
2nd Possible Date Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2021 2022
3rd Possible Date Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2021 2022
Desired Start Time Hour 1 2 3 4 5 6 7 8 9 10 11 12 Minute 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 am pm
Do you want SWS to manage logistics and registration? * Yes No
Who will be attending the training? Undergraduate students Graduate students Staff Faculty
Anticipated number of participants
Have attendees had previous training on this topic? Yes No
Are there any special accommodations attendees will need (i.e. materials available in alternative format)? * Yes No
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