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* 1. What is your full name?

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* 2. What is your role?

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* 3. What is your email address?

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* 4. What is your phone number?

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* 5. What is your preferred method of contact?

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* 6. What type of education agency do you represent?

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* 7. What level of CSTAG training are you requesting?

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* 8. Please select your first preferred training date.

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?

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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?

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

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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.

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