Training Inquiry Questionnaire Lash and Associates Publishing/Training Inc.
Please fill out this Training Inquiry Questionnaire and we will send you a free detailed cost proposal that will directly respond to your needs. I am interested in developing a training program for… Half Day Full Day ___ Days 1 Time only A Training Program ___ Times/Yr. Number of attendees… 1-10 10-25 The training program will be on… Adults with Brain Injury
25-50
50-100
_______
Children and Youth with Brain Injury
The attendees will work in the following settings… Hospital Rehabilitation State Agency Private Practice Brain Injury Association
School Community Agency Group/Residential Program Other ________________________
Background of attendees… Parent Survivor Educator Clinician Rehabilitation Voc Rehab Psychologist Case Manager Social Worker Physical Therapist Occupational Therapist Other ________________________________________________________________ I would like to discuss options for… On-site Training Teleconference Format What level of information do you need… Basic Intermediate
On-line Course
Advanced
What specific training and consultation needs do you have… ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ____________________________________________________________ Please provide a brief overview of the kind of services you provide… ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ____________________________________________________________
What time frames do you have for training… ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ____________________________________________________________ Would you like follow-up consultation and case review… Yes No Maybe
Comments… ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ____________________________________________________________ Please provide us with the following information or calling card… Name ___________________________________________ Title ___________________________________________ Company _________________________________________ Address __________________________________________ City ___________________________________________ State ______________________ Zip__________________ Phone ___________________________________________ Fax ___________________________________________ E-Mail ___________________________________________ Web Site _________________________________________ What is the best time to contact you? ___________________________________________
Thank you for filling out this Training Inquiry Questionnaire. Please mail this and The Menu of Training Topics to us in the enclosed return envelope or mail to: Lash & Associates Publishing/Training Inc. 708 Young Forest Drive Wake Forest, NC 27587 We will give you a call to review your training requirements. If you would like to call us, please do. Ask for Bob Cluett (919) 562-0015
Thank You
Menu of Training Topics Lash and Associates Publishing/Training
What topics interest you? This is a general list of topics to choose from. Others can be developed and designed for your specific needs. Topics can be presented individually or combined. Please check all that interest you. Understanding the Brain and the Effects of an Injury Brain injury in children Brain injury in adults Concussion and Mild Brain Injury Sports and concussion among school age children Effects of concussion among adults Treatment of post concussion syndrome Challenges of Behavior after Brain Injury Challenging behavior among children Challenging behavior among adults Staff behavior management and motivation Positive behavioral supports Least restrictive treatment Eliminating seclusion and restraint Neuropsychopharmacology Medication issues for children Medication issues for adults Family Stress and Coping Grieving, communication and supports for caregivers Families as case managers and partners with professionals Establishing effective circles of support Educating Students with Brain Injury Identifying students Methods for assessment in schools Developing effective IEPs Teaching strategies for the classroom Managing behaviors in school Cognitive communicative needs and strategies Communication aids via technology Community Inclusion and Integration Social skills training within and across age spans Patterns of productive activity Vocational Skills and Work Evaluations of vocational skills and readiness Job seeking skills training Returning to work and negotiating accommodations
Speech and Language Cognitive communication Swallowing and dysphasia Adaptive and augmentative communication Program Development, Monitoring and Management Consumer directed programming Outcome directed programming Data management and program integration Accreditation Creative fundraising Grantsmanship Comments… ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ____________________________________________________________