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Chrysalis Training Request Form

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Your Name:
Email Address:
What kind of Training would you like to schedule?
	Leadership Development Conference
	Spirituality Development Conference
	Basic Youth Advisor Training
	Advanced Youth Advisor Training
	Chaplain Training
If you would like to schedule a Groundwork Anti-Racism Training, please visit the Groundwork website. Please note that these trainings are scheduled directly through the Groundwork program, and a different set of fees applies.
What are your ideal dates for this training?
From:
Through:
What are your second-choice dates for this training?
From:
Through:
Where will this training be held?
Site Name (church):
Address 1:
Address 2:
City:
State:
Zip:
District/Region:
Sponsoring Group:
Closest Major Airport:
Please provide contact information for this event's Contact Person / Coordinator:
Coordinator is:	A Youth
	An Adult
Full Name:
Home Phone:
Work Phone:
Email:
Address 1:
Address 2:
City:
State:
Zip:
Please provide contact information for this event's Registrar:
Registrar is:	A Youth
	An Adult
Full Name:
Home Phone:
Work Phone:
Email:
Address 1:
Address 2:
City:
State:
Zip:
Where should the Training Resource Box be sent?
	Site Address
	Coordinator Address
	Registrar Address
Where should the Youth Office invoice for the $750 travel equalization fee be sent?
	Site Address
	Coordinator Address
	Registrar Address
	Fax Number:
Are there any major issues the trainers should know to prepare for this conference? (Is the district/region in transition of leadership, are there problems, what is the state of youth adult relations, have you had other trainings in the past, etc.):

Depending on the type of training you are requesting, tell us the state of Leadership, Spirituality, Youth Advisory, Anti-Racism, and Youth Chaplaincy in your district/region:

Who will attend? (New advisors, younger youth leaders, half ministers, half youth, YAC members, etc.) What is the expected attendance in numbers?

Please give us a list of people (if applicable) to contact in the district/region to gather more information about the state of affairs.
Youth Committee (YAC/DYSC) Chair
Name:
Official Title:
Phone Number:
Email Address:
Social Action Coordinator (SAC)
Name:
Official Title:
Phone Number:
Email Address:
Youth Council Representative (YCR)
Name:
Official Title:
Phone Number:
Email Address:
Adults on YAC/DYSC
Name:
Official Title:
Phone Number:
Email Address:
RE Committee Chair
Name:
Official Title:
Phone Number:
Email Address:
District/Regional Youth Programs Coordinator (Adult)
Name:
Official Title:
Phone Number:
Email Address:
Other Key People
Name:
Official Title:
Phone Number:
Email Address:
I understand that the Youth Office will be responsible for purchasing travel for the two trainers. In exchange, we will the sponsoring organization named above will pay theYouth Office a $750 travel equalization fee.
In addition to the UUA Travel Equalization Fee, there is a required honorarium to be paid to each each trainer. The UUA recommends a $300 fee, covering 1) Fri-Sun training, 2) travel time, and 3) phone time to talk with you in advance about your district/region.
We plan to give each trainer a stipend of:
	$300
	$325
	$350
We are aware that any Youth Office training should be scheduled a minimum of three months in advance, and that service will be much better if it is scheduled six months in advance.

For more information contact youth @ uua.org.

Last updated on Friday, April 18, 2008.