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Parent Training and Information Center Virtual Workshop Request 2023-24

Host Contact Info:*
If you are a school employee requesting on behalf of a SEPAC, please include a second contact from the SEPAC in the field provided below.
First Last
Phone:*
For contact purposes only. Information will not be shared publicly.
Email*
For contact purposes only. Information will not be shared publicly.
Secondary Contact Info:
First Last
Secondary Contact Phone Number:
For contact purposes only. Information will not be shared publicly.
Secondary Contact Email
For contact purposes only. Information will not be shared publicly.
Organization type:*
- SEPAC/School District - MassPAC Member
- SEPAC/School District - MassPAC Non-member
- Early Intervention Program
- Community Based/Human Service Agency
- Medical Office
Requesting School/SEPAC*
Organization Name*
Virtual Workshop request:*
Preferred Date*
MM slash DD slash YYYY
Secondary Date*
MM slash DD slash YYYY
Preferred Start Time (A minimum of 2 hours is required):*

: Hours

Minutes

AM/PM
Do you want to request a second workshop?
Second Virtual Workshop request:*
2nd Workshop Preferred Date*
MM slash DD slash YYYY
2nd Workshop Secondary Date*
MM slash DD slash YYYY
2nd Workshop Preferred Start Time (A minimum of 2 hours is required):*

: Hours

Minutes

AM/PM
Intended Audience:*
Will your district be hiring interpreters for this workshop?
We can support simultaneous interpretation for virtual workshops through Zoom. If you are hiring interpreters, please email Kristin LaRose at workshops@fcsn.org with the interpreter(s) name, email and language they will be interpreting for.
Would you like to request this workshop to be in person?
I would like to request this workshop to be in person.*
- Check here that you understand that this is not guaranteed and if there is not a presenter available in your area then the workshop will be presented through Zoom.
For all School District payments, please provide Purchase Order number for invoicing:
If your school district requires a purchase order number that you do not have it at this time, please email workshops@fcsn.org once you obtain the PO#. Please include your town and the requested workshop title in the subject line.
Workshop Pricing*
The Parent Training and Information Center (PTIC) has three price levels for workshops.

If you are a current MassPAC Plus member, one workshop from our Basic Rights Series is included in your membership. We ask that all workshop hosts fill out the billing information but an invoice will not be sent for current MassPAC members requesting the Basic Rights workshop.

$495.00 - This is for all workshops including Bullying and Turning three for School Districts/SEPACS (MassPAC non-member), Community Based/Human Service Agencies and Medical Offices.

$247.50 - This is for a second workshop request by a MassPAC member.

No Cost - Turning Three Essentials workshop for Early Intervention programs only.

Please note that if you are a current MassPAC Plus member, any additional workshops after your second request will be invoiced at $495.00 each.
- I agree to the above terms.
Billing Information*
First Last
Address*
Street Address City State ZIP Code
Billing Phone*
Billing Email*
Special Notice
Special Notice: If you do not receive a confirmation email after submitting your form, your request was not received. Please attempt to resubmit using another browser and email workshops@fcsn.org to verify that we have received the request only after you submitted the request for a second time.

Parent Training and Information Center Virtual Workshop Request 2023-24

Special Notice

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