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1. What is your full name? (Required.)

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2. What is your role?

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3. What is your email address? (Required.)

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4. What is your phone number? (Required.)

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5. What is your preferred method of contact? (Required.)

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6. What type of education agency do you represent? (Required.)

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7. What level of CSTAG training are you requesting? (Required.)

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8. Please select your first preferred training date. (Required.)

Date

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9. Please select your second preferred training date.

Date

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10. Please select your third preferred training date.

Date

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11. Do you have a space with audiovisual capabilities and space for the requested group of trainees? (Required.)

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12. Are you willing to allow participants from outside of your school or organization?

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13. Does your education agency have funds to pay for trainer fees associated with CSTAG training? (Required.)

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14. Does your education agency have the funds to cover any travel expenses incurred by trainers conducting your requested workshop? (Required.)

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15. Please identify whether or not you would like to opt-in to receiving communications from the Arizona Department of Education School Preparedness team. (Required.)

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