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 Country

Email*

Phone*

1. What topic most interests you? Please check all that apply:

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*

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Foster Adopt Minnesota Education Program

Presenter Interest Form

Presenter Interest Form

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