Fall 2024 CalSAC Trainer Network Enrollment Form

PARTICIPANT INFORMATION

First Name: *

Last Name: *

Primary Phone: *

Cell Phone: *

Work Phone: *

Primary Email:

Alternate Email:

I will submit the 2024 Trainer Agreement Form by Friday, October 18 (This form is to confirm supervisor support.)

I, or my sponsoring organization, will submit payment by Friday, November 1*

I will attend the scheduled 60-minute Trainer Orientation Webinars.

I will complete the online Trainer Self-Assessment by Friday, November 1

I will participate in the full 3-day Training of Trainers Institute (ToT) on November 7-9 2024 in Oakland, CA

I will complete the certification process with the support of a CalSAC Mentor and CalSAC staff.