Workshop Planning Form

If you would like to offer a Leadership Valencia class please fill out and submit the following form.

  Workshop Title:  
Email: 
Workshop Date: 
Times:  to   a.m.p.m.
Maximum Workshop Size: 
Minimum Workshop Size:  
Facility Requested: 
(You are responsible for reserving all rooms)

  Workshop Purpose:  (Please state the purpose exactly as you want it to read in the Program Schedule)


  Workshop Presenter(s) and Title(s)
(Include company if not Valencia employee)

  Workshop Coordinator:
Ext. Fax:

 Workshop Category: 

Focus on Learning

Professional Practices
Management & Supervision Technology
Important General Stuff

  Target Audience:
Career Department Chairs
Faculty Managers
Other (Specify) 

  This workshop is:
open to all employees  Restricted to staff categories indicated.

  Are registrations to be processed by someone other than the LEADERSHIP VALENCIA office?    yes   no
If yes, person to contact to register:
  Ext: 

  Instructional materials or supplies needed?  none  yes, as follows:   (Please call Fiona Baxter, ext. 3122, if funding is needed for workshop materials)

 A/V equipment needed?  none   yes, as follows:  (You are responsible for reserving equipment at all locations)

Leadership Valencia Task Force Member
  Ext.

Task Force Committee Chair:
  Ext.