Walkable Community Workshops
preliminary application
Contact Information
First Name:
Last Name:
Agency:
City:
State:
Email:
Community Assessment
Indicate Which Workshop Package you are Interested in:
8 Workshops, 2 Facilitators
5 Workshops, 2 Facilitators
1 Facilitator, 1 Day (daily rate)
Workshop Coordinator Training Only
What Options are you Interested in? Check all that apply
Standard Walkable Community Workshops
Safe Routes to School
Bikeable Community Workshops
Phase 2 Workshops
Other:
Where are the critical needs in your community? Select two.
Increasing Rate of Obesity
Poor Air Quality
Lack of Bike Routes
Lack of Community Identity
Too few Children Walking or Biking to School
Generating Public Support for Bicycling & Walking
Lack of Parks and Playgrounds
Getting to the Next Step
Tell us briefly why you would like to be a part of this program.
Please limit your response to fewer than 500 words.
Client Readiness
How soon would you be interested in hosting Workshops?
Spring 2006
Fall 2006
Early 2007
To be determined
Would you be interested in attending the DC training?
Yes
No
Would you like to be notified via email about upcoming NCBW training opportunities?
Yes
No
Many times we get inquiries from people within the same agency,
or within the same city or county. Would you like to know if people in
your area have contacted us about these workshops?
Yes
No
Next Steps
Once you submit this form we will contact you via phone within a week.
Phone
(
)
-
When is the best time to reach you?
Specify a Time
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Morning
Late Morning
Afternoon
Late Afternoon