Professional Development Workshop Request Form

School/Organization Details

School/Organization Name

School/Organization Address

Street

School/Organization City

School/Organization Province or Territory

Postal Code

Country

School/Organization Contact

First Name

Last Name

Title

Work Email Address

Workshop Details

Workshop Date

Workshop Time (including time zone)

Workshop Length

Workshop Topic Options (+Ctrl to select multiple choices)

Please share the desired learning outcomes

Audience

Other - Please specify

Projected # of Attendees

Request for Virtual or In-Person Presentation:

(Please note that in-person presentations are subject to availability.)

Preference for Hosting Virtual Event

Virtual Platform

Other - Please Specify

Virtual Event Contact

Please include details of the contact who will be able to provide the virtual event and registration/attendance information.

First Name

Last Name

Email Address

Location

Workshop Location Address

Is the location accessible?

Additional Comments

Other

Has the audience participated in other professional development opportunities offered by the Rick Hansen Foundation?

If yes, which of the following?

Are you interested in also hosting student sessions with an RHF Ambassador with lived experience?

How did you hear about us?