Foster Adopt Minnesota Education Program Presenter Interest Form Please complete the following if you would like to be a presenter for Foster Adopt Minnesota. Presenter Interest Form Name* First Last Legal Name (if different than above) First Middle Last Pronoun(s)* She/her/hers They/them/theirs He/him/his Other Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Phone*1. What topic most interests you? Please check all that apply: Adolescent Sexual Health Attachment Relationships with the foster/adoptive child’s family of origin Child Development Children’s Mental Health Domestic Abuse Effects of Trauma Fetal Alcohol Spectrum Disorder Grief & Loss Impact on Children in the Home Kinship Care LGBTQ Youth and Families Marital Challenges Race & Culture Sexual Topics Dialogue/Sexual Behaviors Substance Abuse 1. Other topics of interest (not listed above): 2. Who do you envision in your audience? AdoptEd: Educational Workshops for Adoptive, Foster, & Kinship Families and Professionals FosterEd: County and Tribal-based Workshop focused for Foster Families and Professionals Professional Workshops: Educational Workshops for Professionals who work with adoptive and foster families. 3. What style of workshops are you interested in exploring? Please check all that apply: In person workshop Webinar Half-day workshop Full- day workshop Workshop series Are you a therapist connected to Foster Adopt Minnesota's HELP Program?* Yes No If no, would you like to learn the benefits of being a HELP-vetted therapist?* Yes No 4. Where in Minnesota would you be interested in presenting? 5. What trainings have you provided in the past? Please provide specific information and make note if you have power points and curriculum you could share with us, if requested.How did you hear about this speaking opportunity?* Referred by Foster Adopt Minnesota Staff (insert name) Referred by (insert name) Internet search Other Referred by: Other: Your Presenter Bio*CAPTCHA Δ Thank you for your interest in collaborating! We will contact you ASAP. Pre-Adopt Education Classes AdoptEd & FosterEd Workshops Certificate of Attendance Webinar Library Podcast Library Interested in Collaborating?