Powerful Tools for Caregivers: Add an Upcoming Caregiver Class Series

Powerful Tools for Caregivers:

Add an Upcoming Caregiver Class Series

This form is for PTC class leaders to add an upcoming PTC caregiver class series.

HELPFUL HINTS:

Use a tablet, laptop, or desktop computer to complete this form.
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Do NOT use the autofill function.

Details of Class Series or Workshop

Please provide the below details about your upcoming PTC caregiver class series or Managing Stress Workshop.

Please only enter the information for one offering per form.

Class/Workshop Start Date*

End Date*

*If entering the Managing Stress Workshop, enter the same end date as the start date.

Class/Workshop Start and End Time*

For example: 10:00 am - 11:30 am

Time Zone*

Please tell us the time zone of this class series.

Select or enter value

Delivery Format*

Virtual

In Person

Caregiver Class/Workshop Audience*

Caregivers of Children

Caregivers of Adults

Class/Workshop Audience and Length*

Select or enter value

Language*

Please select which language the class series will be held.

English

Korean

French

Spanish

Is this class series open to the general public?

Yes

Would you like this class series added to the PTC website for promotion?

When applicable: Please be sure to indicate if the class is restricted to specific places or diagnoses (e.g. limited to Washington residents; limited to caregivers of someone with Alzheimer's disease) in the "Additional Information" box below.

Yes, please

No, thanks

Is there a fee for class participants?

If you say "no", we will interpret this as it was "free" to caregivers.

Yes

Please indicate the fee amount below.

Organization or Registration Website Link

Please share a link with more details about the PTC classes, such as an organization website or registration link. Please do not provide the name of the organization, but rather the URL link.

Example: https://powerfultoolsforcaregivers.org

State or Province*

If a virtual event, select the state the leaders will be located during the event. If your option does not exist, locate "Write-in option" at the bottom of the list.

Select

State write-in option

Country

Select or enter value

Additional Information

For example:

Limited to residents of [state/city/county]

Respite services provided during class series

Specific address and name of host organization for in-person class series

Class Series Registration Information

Email for Registration Point of Contact*

Please provide an email address for the point of contact for caregiver participants.

Name for Registration Point of Contact

Please provide a name to go alongside the email address as the point of contact for caregiver participants.

Phone Number for Registration

Class Leader Information

Thank you for sharing details about upcoming caregiver classes.

Please provide information for the two (minimum) required Class Leaders/Master Trainers facilitating the Powerful Tools for Caregiver class series or Managing Stress Workshop.

This contact information will not be shared with the event if it is not the registration email address.

#1 Class Leader Name*

#1 Class Leader Email*

This should be the personal/work email associated with #1 Class Leader.

#2 Class Leader Name*

#2 Class Leader Email*

This should be the personal/work email associated with #2 Class Leader. Every facilitator should have their own email address.

#3 Class Leader Name

#3 Class Leader Email

This should be the personal or work email associated with the #3 Class Leader.

Any other notes about this submission

Optional: Please communicate additional notes about the class series or class leaders here, including if a facilitator has yet to complete training but will complete training before the submitted class series.

Single Point of Contact

If you would prefer one person (e.g. program manager, event/volunteer/program coordinator) to manage this class series instead of all Class Leaders being involved, please provide their point of contact information here. If you select this option, the listed Class Leaders/Master Trainers facilitating this class will not receive any emails from PTC Headquarters.

Would you like a single point of contact to receive all communications regarding this class series?*

Yes

Name (first and last) for Point of Contact

Email for Point of Contact

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