*1.First and Last Name(Required.)

*2.Email Address(Required.)

*3.In which of the following sectors do you work?(Required.)

Community Action

K - 12 Education

Higher Education

Nonprofit (other than Community Action)

Social Services

Local Government

Other (please specify)

4.For what group(s) do you anticipate conducting the Poverty Simulation?  (For example: medical students, incoming teachers, community officials, social service providers, etc.)

*5.Please share your previous experience with the Community Action Poverty Simulation.  (Select all that apply.)(Required.)

I have never seen a Poverty Simulation.

I have only observed (never participated in) a Poverty Simulation.

I have participated in a Poverty Simulation as a family member.

I have volunteered in a Poverty Simulation as a community resource provider.

I have facilitated Poverty Simulations.

6.Does your organization currently experience any difficulties facilitating the Poverty Simulation that you hope will be addressed in this training?  Please share more information.

7.What are you hoping to gain from this training?

8.Do you have any dietary restrictions we should be aware of as we plan or lunch menu for this event?

9.Do you require additional accommodations in order to attend this event?  If so, please explain below.  A member of staff may reach out for additional information to help coordinate.