Training Event Request Form

Training Event Request Form

(For C.A.S.E. Staff Internal Use Only)

This form must be submitted a minimum of FOUR weeks prior to the first date of registration for the event. If CEUs are required, please allow for an 8 week minimum.

Training Event Request Form

"*" indicates required fields

Name of Requestor*
Please list Title of the Event or Topic Requested.
Please provide the Presenter's Title, Credentials, Affiliation, Social Media Handles, Email Information etc.
Please indicate if there are any associated costs for the training (ex. registration fee, participant cost, fee for service due to C.A.S.E. etc.)
Type of Event*
Please select the time zone for the event*
Is this a support group?*
If yes, please select if it will be psychoeducational or clinical in nature. If you choose clinical, a HIPPA compliant Zoom link must be sent along with the request form. In addition, the therapist conducting the group must enter notes in Penelope after each session.
If you are requesting a support group, please select the type of support group below:
Is this event grant related?*

Please list a name and number of an the contact person if the event is hosted by another organization.
Will you need the Training Department to create a Zoom link to provide to participants?*

If you selected yes for a Zoom link, please indicate the format needed below.

If you (not the Training Department) are providing the Zoom link, please list in the space provided below.
Does this event require marketing?*

Please indicate if you would like this event listed on the C.A.S.E. website or if the event is designed for a pre-determined audience. (ex. Virginia Social Workers Only)
Are Certificates of Attendance required?*

Who will distribute the training certificates?
Will CEUs be provided?*

If CEUs are required, please select the type:
Only complete this section if CEUs are required for the event.
Who will distribute the training surveys?

Required Supplies
Please select the supplies you will need for the event.