Professional Development Needs Assessment Sheet
Please take a moment to fill out all of the necessary information in this survey so that we may provide a training session that meets all of your training goals and needs. It will also allow us to recruit the most appropriate trainer(s) to work with your team of professionals.
Sales Representative:
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Please Select
Bisignano, Kip - DC, GA, MD, NC, VA, WV
Bourque, Judy
Choquette, Holly
Open Territory - AK, ID, MT, OR, WA
Ferry, Melanie
Hardy, Susan - FL, GA, W. NC, SC
Isbell, Verne - AR, LA, OK, TX
Kane, Jacob - CT, ME, NH, NY, VT
Laroussi, Kathy
Larson, Bjorn - IA, MN, MO, ND, SD
Marcus, Janice
Moore, Karen
Onyeani, Chika - DE, NJ, NYC, Long Island
Ostler, Maggie - UT, S. CA, C. CA, HI
Pacheco, Richard - AZ, NV, S. CA, N. CA
Patrick, Eileen - CO, KS, NE, NM, WY
Partyka, Diana - MA, RI
Schutter, Kathleen - KY, MI, OH, TN
Van Order, Dean - IL, IN, WI
Webster, Kathy
Wells, Meredith - AL, FL, MS, SC, TN
Wilson, Dawn - PA
Type of Training:
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Pre-Sale Presentation
Post-Sale Implementation
Pilot Training
Preferred Training Date(s):
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Approx number attending per grade level (please note: 32 maximum per trainer)
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School/District:
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City, State:
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Training Contact:
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Email Address:
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Phone Number
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Area Code
Phone Number
Please state the goals and purpose for this training session (please include any details such as grade levels, areas to focus on, what edition of FOSS, etc):
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Training Details and Logistics
Please complete as much information as possible and check off all items that apply.
Physical Address of Training Site:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Are there any unique driving or parking directions our Consultant(s) should be made aware of:
Are the participants required to attend this session or is it an option for them to attend? Are there other sessions from which the participants will choose to attend? Will the participants be pre-registering for our session? Please provide as much detail regarding the numbers of participants we should anticipate/prepare for and if there will be other sessions "competing" for attendance.
On-site Contact Name:
*
On-site Contact Mobile Number:
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Start Time:
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AM/PM Option
End Time:
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Lunch Start Time (if applicable):
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AM/PM Option
Lunch End Time
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AM/PM Option
Will the Participants be leaving the premises for lunch? (if applicable)
Yes, most or all will leave
No, all will have lunch on site
Combination, option for Participants to bring lunch or leave for lunch
Unsure at this time
Does Not Apply
Other
Will lunch be provided for our Consultant(s)? (if applicable)
Location of Training Room (Room #, Floor #, Elevator access if not on ground floor):
Date/Time when trainer can access training room for set-up (day prior, morning of, time):
*
Please check all items below that will be available for training session. The ideal set up would be a room with tables with close access to water and wifi access for all attendees.
Desks
Tables (preferred)
Availability to water
Wi-fi access
LCD Projector
Document Camera
Interactive White Board
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Training Materials and Logistics
Please check off as much information as possible so that we can best prepare for your training session(s). We will work collaboratively with you to design a training that meets your teachers' needs and thoroughly explains the FOSS program.
Experience of Participants:
*
First Time FOSS Users
Current FOSS Users
Mix of New and Current Users
Check all that apply:
District Kits will be available for training use
Kits have been received from order
Teachers will have own Investigation Guides (we strongly encourage teachers to bring their own manuals so that notes can be taken directly within their guides)
Additional Notes:
Check off kit titles for Professional Development FOSS Training at Grades K-5:
Animals Two by Two, NG Edition
Animals Two by Two, 3rd Edition
Trees and Weather, NG Edition
Trees and Weather, 3rd Edition
Materials and Motion, NG Edition
Materials in our World, 3rd Edition
Plants and Animals, NG Edition
Plants and Animals, 3rd Edition
Air and Weather, NG Edition
Air and Weather, 3rd Edition
Sound and Light, NG Edition
Balance and Motion, 3rd Edition
Insects and Plants, NG Edition
Insects and Plants, 3rd Edition
Pebbles, Sand, and Silt, NG Edition
Pebbles, Sand, and Silt, 3rd Edition
Solids and Liquids, NG Edition
Solids and Liquids, 3rd Edition
Structures of Life, NG Edition
Structures of Life, 3rd Edition
Water and Climate, NG Edition
Water, 3rd Edition
Motion and Matter, NG Edition
Measuring Matter, 3rd Edition
Environments, NG Edition
Environments, 3rd Edition
Soils, Rocks. and Landforms, NG
Soils, Rocks, and Landforms, 3rd Ed
Energy, NG Edition
Energy and Electromagnetism, 3rd
Living Systems, NG Edition
Living Systems, 3rd Edition
Earth and Sun, NG Edition
Sun, Moon, and Planets, 3rd Edition
Mixtures and Solutions, NG Ed
Mixtures and Solutions, 3rd Edition
Weather on Earth, 3rd Edition
Motion, Force, and Models, 3rd Ed
Check off kit titles for Professional Development FOSS Training at Grades 6-8 (** notes short courses, NG Edition):
Electromagnetic Force**
Weather and Water, NG Edition
Weather and Water, 2nd Edition
Diversity of Life, NG Edition
Diversity of Life, 2nd Edition
Chemical Interactions, 2nd Edition
Populations and Ecosystems, 2nd Ed
Gravity and Kinetic Energy **
Waves**
Planetary Science, 2nd Edition
Human Systems Interactions**
Heredity and Adaptation**
Please indicate Delta Science Module titles for Professional Development Training at Grades K-8:
Please indicate if you would be interested in future training on the following topics:
FOSSweb
Assessment
FOSSmap
Next Generation Science Standards
The 5 E's of Science
Science/Engineering Practices
Disciplinary Core Ideas
Crosscutting concepts
Science/Literacy Connections
Other
Please list any additional information that will be helpful for us in delivering successful training sessions for your team!
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