Training Title & Summary Form

Your Name*

Legal Name (if different than above)

Pronoun(s)*

She/her/hers
They/them/theirs
He/him/his
Other

Email*

Date of Training*

Time of Training

:

County/Tribe/Location of training:*

Are you open to MN ADOPT recording this live webinar to add to our webinar library?*

If yes, is there a specific timeline you’d like it in the library (ie 2 weeks, 2 months) or can it be added indefinitely?

Workshop Title:*

Workshop Description*

Target Audience:*

Parents
Professionals
Parents & Professionals

Level of Training*

Ages addressed: (check all that apply)*

Select All
0-5
6-11
12-18

Presenter Fee:*

Please include any additional information in regards to payment. Examples: splitting fees with a co-presenter, paying organization instead of individual, etc.

For All Workshops/Webinars:*

Please check this box to acknowledge the following video sharing policy.

Your webinar shall not include any material belonging to anyone other than the Speaker (e.g. YouTube videos, clip art) unless Speaker has lawfully purchased the right to use the material in the webinar. If Speaker is uncertain whether material may be used in a webinar, Speaker will ask MN ADOPT before including the material. Note, this video https://www.youtube.com/watch?v=eLVrLlI7rAg has good information if Speaker is planning to share a video.

Based on the information above, do you plan to share a video during your webinar or in person workshop:*

Yes
No
Unsure at this time

For All Workshops/Webinars:*

Please check this box to acknowledge the following cancellation information.

Cancellation policy:
MN ADOPT will closely manage the number of attendees for any workshop. If there are fewer than 10 people registered one week before the event, MN ADOPT will be in contact with the speaker and together decide to cancel the workshop.

If MN ADOPT decides to cancel the event due to low attendees, bad weather, or other unforeseen circumstances – or – if the speakers cancels for any reason, the speaker will not be paid for services.

For FosterEd Workshops ONLY:

Please check this box to acknowledge the following reimbursement information.

- Hourly rate: $175/hour for a live in-person workshop.

- Mileage: Mileage over 30 miles one way will be paid for at the Federal IRS reimbursement rate.

- Lodging: Hotel accommodations will be paid for traveling more than 100 miles one way and up to $125/night. Lodging reimbursement must be agreed upon with MN ADOPT before the workshop date.

- Meals: Trainers can be reimbursed for meals up to $10 for breakfast & lunch, and up to $16.00 for dinner. Meal reimbursement must be agreed upon with MN ADOPT before the workshop date.

For FosterEd Workshops ONLY:

Please check this box to acknowledge the statement about the curriculum review below.

You will need to create a curriculum based on the Outline MN ADOPT has provided you, which has been approved by DHS. Your curriculum needs to include:

a. Education: Research and evidence-based materials
b. Strategies and tools the caregiver can bring home right away
c. Resources for foster families to access
d. Interweave Culture, Trauma, LGBTQ, Equity, Race, and Loss/Grief into your workshop

Curriculum, handouts, and/or power points need to be submitted to MN ADOPT 2 weeks before the training date. MN ADOPT Education coordinators will review the materials and offer feedback in a timely manner, so any changes can occur before the event.

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