Name: Title/Profession: School District / Organization: Email: Phone: City: State: —Please choose an option—ALAKASAZARCACOCTDEDCFMFLGAGUHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVIVAWAWVWIWY If you already know that you would like to bring an Essential Elements workshop to your community, please fill out this additional information. Please submit three potential dates for the workshop: Approximately how many educators would you be able to recruit to participate in the workshop? I am interested in holding more than one workshop. I am able to provide a space for the workshop that has projection, sound, and internet capabilities. In order for educators to be offered professional development credit, (CEU's, CEC's, PLU's, etc.) what would CEF need to provide? How did you hear about Essential Elements?