<p> Bureau of Criminal Apprehension Criminal Justice Training & Education Training Request Form</p><p>COORDINATOR INFORMATION</p><p>Last First</p><p>Agency</p><p>Street Address</p><p>City State ZIP</p><p>Phone E-mail Address</p><p>COURSE INFORMATION</p><p>Course Title</p><p>Dates Times</p><p>Post Credits Course Cost</p><p>Location (include Address)</p><p>Course Prerequisites:</p><p>Course Description:</p><p>Course Sponsorship:</p><p>Audience (i.e. law enforcement, dispatchers, etc.): </p><p>Number of Students:</p><p>Yes No Will students register for course on the BCA CJTE site? (registration through this site is for BCA classes, or classes sponsored or done in partnership with the BCA. This is required for course rosters, POST credits, certificates, etc.)</p><p>Training Room Requested:</p><p>W-278 Computer Classroom (capacity 22) W-272 West Class (capacity 30)</p><p>W-273 East Class (capacity 30) W-277 Multi Purpose (30)</p><p>W-249 Lab (40) W-270 Auditorium (capacity 150)</p><p>INSTRUCTOR NAMES PLEASE INCLUDE INSTRUCTOR RESUME WITH REQUEST. Yes No Is an instructor contract needed?</p><p>Full Name Title</p><p>Phone ( ) Email Address</p><p>Full Name Title</p><p>Phone ( ) Email Address</p><p>Last revised date: 4/15/2010 Equipment Needed*: Food:</p><p>Laptop Yes No If yes, please indicate if you will provide or if BCA will be handling.</p><p>Overhead Projector</p><p>Proxima Breakfast: Speakers Lunch: Slide Advancer Breakouts: Flip Charts</p><p>Extension Cord Any other details/special requests:</p><p>Power Strip</p><p>Key Cards</p><p>IT Support (i.e. access to internet)</p><p>*Please note: Our Equipment only supports Office 2007.</p><p>Yes No Clerical help needed: this is provided to BCA sponsored courses. Which includes handouts/materials, certificates, name tents, rosters, etc.) If yes, someone will contact with clarification of what is needed.</p><p>Yes No Certificates</p><p>Yes No Name Tents </p><p>Yes No Roster/Sign-in sheet </p><p>Yes No Copies of Handouts/materials. (All handout materials must be emailed to [email protected] no later than 2 weeks prior to the course. Presenters are responsible for their own handouts if they fail to meet this timeline).</p><p>Signature Date</p><p>FOR CJTE OFFICE USE ONLY REVIEWED BY Title</p><p>APPROVED BY Title</p><p>DATE APPROVED</p><p>DATE POSTED</p><p>Yes No</p><p>Special Expense</p><p>Purchase Order</p><p>Instructor Contract</p><p>POST #</p><p>Last revised date: 4/15/2010</p>