Service Provider Training Request Form Please fill out this form to request service provider training for your organization/team. This form is for service provider training, if you want to book a community workshop, please click here. SERC Training Institute Professional Education and Training Request Form Step 1 of 3 33% Please Note We request a minimum of 4-6 weeks advance notice for training and consultation requests Name* First Last Job Title*Organization*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Contact Email* Phone*Training Topic Areas*Teaching Sexuality: Facilitation Skills for Service ProvidersTeaching Sexuality Education within the MB Provincial Phys. Ed. & Health CurriculumTeaching Birth Control and ST/BBIs: Foundations for Service ProvidersLGBT2SQ+ Inclusion and AllyshipSexuality and Cultural Diversity: Supporting NewcomersSexuality in our work with Children and YouthSexuality in our Work with People Labelled with Intellectual / Developmental DisabilitiesSexuality Policy, Program Development and EvaluationOther: Please contact me to discuss customized trainingPlease choose a training topic or subject area that best suits your needs. Tell us more about your specific needs.*Sector*EducationHealth CareSocial ServicesChild WelfareCliniciansMental HealthHealth PromotionGovernmentPrivate SectorCorporateCommunity GroupsSettlementFamily and Caregiver SupportOtherPlease Specify*Size of Group*10-1415-2021-2526-3031-3536-40Occupation(s) of Participants*Tell us about the work roles of the training participants. Length of Training*Half Day (3 hours)Full Day (6 hours)One hour presentation / Lunch & LearnOtherPlease Explain*Location of Training*Mileage ReimbursementNot ApplicableYesNoPlease contact me to discussFor training outside Winnipeg or Brandon city limits, we require mileage/travel and accommodation reimbursement. Can you accommodate this expense?Please provide parking instructions, if applicable*Training Date - First Choice* Preferred time*ampmeveningall daynoon hourTraining Date - Second Choice Preferred Timeampmeveningall daynoon hourTraining Date - Third Choice Preferred Timeampmeveningall daynoon hour Select Fee Schedule*Half Day (3 Hours) - Not for Profit Subsidized Rate - $300Full Day (6 Hours) - Not for Profit Subsidized Rate - $500Half Day (3 Hours) - Standard Rate - $400Full Day (6 Hours) - Standard Rate - $800Please contact me to discuss the Fee ScheduleWhat are your desired learning goals?*Has your organization had training or education on the topic of sexuality before? Please explain.*Please tell us anything else that will help us process your request.