Parent Education Mini-Grant Application:
Name _________________________________________________________________________
Address _______________________________________________________________________
______________________________________________________________________________
Phone Number - Daytime: _________________________ Evening: _________________________
Trainer Name/s: (one or two)
1)
2)
What number of Parent Ed. sessions are you planning to offer? (Check one)
| 1_____ | 2 _____ | 3 _____ | 4 _____ |
Dates, times and location for your sessions:
Describe the target audience for your parent education sessions and how you will publicize the sessions:
Do you need help from the Adolescent Health Specialist to publicize your workshop or develop your agenda? If so, what do you need?