Skip to content
user
Login
Search for:
Method + Research
Conscious Discipline Methodology
Brain State Model
School Family
Seven Powers
Seven Skills
Research
Professional Development
Professional Development
Implementation Support
Events
Onsite Training
Instructors
E-Learning & Digital Classes
E-Learning & Digital SEL Classes
Online Courses & SEL Distance Learning
Webinars
Podcast
Free Resources
What’s Included
Free-For-All
Free Membership
Premium Membership
About
About Us
Becky Bailey
Media
Honors & Awards
Celebrations
Careers
Contact Us
PDF Catalog
Blog
More
Shop
Method + Research
Conscious Discipline Methodology
Brain State Model
School Family
Seven Powers
Seven Skills
Research
Professional Development
Professional Development
Implementation Support
Events
Onsite Training
Instructors
E-Learning & Digital Classes
E-Learning & Digital SEL Classes
Online Courses & SEL Distance Learning
Webinars
Podcast
Free Resources
What’s Included
Free-For-All
Free Membership
Premium Membership
About
About Us
Becky Bailey
Media
Honors & Awards
Celebrations
Careers
Contact Us
PDF Catalog
Blog
More
Shop
stars
Blog
user
Login
Search for:
menu
cross
Instructor Request Form
Please complete and submit the form below.
*are required fields
All requests should be completed
at least 60 days
prior to the requested date of your training. You will need to have a training date in mind when submitting your request.
While we strive to accommodate every request for training we receive, we cannot guarantee a trainer will be available for the exact requested date of your training, or if you have requested a specific trainer, that they will be available for the requested date of your training. You will be provided options in the situation your original request cannot be granted.
Please allow us a
minimum of 2-3 weeks
to process your request. Once we have verified the availability of a trainer, we will prepare an agreement for your acceptance.
Upon return of the signed agreement the date is reserved for your group and the details of your training are finalized.
Daily rate includes 6-hours of training with an hour break for lunch (7 hours).
If you have any questions or need further assistance,
contact us at 800-842-2846
.
Please check to proceed.
*
I have read and accept the terms above.
Contact Information
Organization Name
*
Name
*
First
Last
Email
*
Phone
*
Phone Ext.
I have been working with the following speaker
Coordinator/manager currently working with
*
I don't know
Ashley Dwyer
Diana Nelson
Erika Bettinger
Katelyn Monahan
Heidi Condrey
Libee Bisping
Priscila Davila
Name of coordinator/manager
Hidden
Coordinator/manager currently working with
*
Country
*
United States
Andorra
United Arab Emirates
Afghanistan
Antigua and Barbuda
Anguilla
Albania
Armenia
Netherlands Antilles
Angola
Antarctica
Argentina
American Samoa
Austria
Australia
Aruba
Aland Islands
Azerbaijan
Bosnia and Herzegovina
Barbados
Bangladesh
Belgium
Burkina Faso
Bulgaria
Bahrain
Burundi
Benin
Saint Barthelemy
Bermuda
Brunei Darussalam
Bolivia
Bonaire, Saint Eustatius and Saba
Brazil
Bahamas
Bhutan
Bouvet Island
Botswana
Belarus
Belize
Canada
Cocos (Keeling) Islands
Congo (Democratic Republic)
Central African Republic
Congo (Republic)
Switzerland
Cote d'Ivoire
Cook Islands
Chile
Cameroon
China
Colombia
Costa Rica
Cuba
Cape Verde
Curacao
Christmas Island
Cyprus
Czech Republic
Germany
Djibouti
Denmark
Dominica
Dominican Republic
Algeria
Ecuador
Estonia
Egypt
Western Sahara
Eritrea
Spain
Ethiopia
Finland
Fiji
Falkland Islands (Malvinas)
Micronesia
Faroe Islands
France
Gabon
United Kingdom
England
Scotland
Wales
Northern Ireland
Grenada
Georgia
French Guiana
Guernsey
Ghana
Gibraltar
Greenland
Gambia
Guinea
Guadeloupe
Equatorial Guinea
Greece
South Georgia and the South Sandwich Islands
Guatemala
Guam
Guinea-Bissau
Guyana
Hong Kong (SAR China)
Heard & McDonald Islands
Honduras
Croatia
Haiti
Hungary
Indonesia
Ireland
Israel
Isle of Man
India
British Indian Ocean Terr.
Iraq
Iran
Iceland
Italy
Jersey
Jamaica
Jordan
Japan
Kenya
Kyrgyzstan
Cambodia
Kiribati
Comoros
Saint Kitts And Nevis
North Korea
Republic of Korea
Kuwait
Cayman Islands
Kazakhstan
Laos
Lebanon
Saint Lucia
Liechtenstein
Sri Lanka
Liberia
Lesotho
Lithuania
Luxembourg
Latvia
Libya
Morocco
Monaco
Moldova
Montenegro
Saint Martin
Madagascar
Marshall Islands
North Macedonia
Mali
Myanmar
Mongolia
Macao (SAR China)
Northern Mariana Islands
Martinique
Mauritania
Montserrat
Malta
Mauritius
Maldives
Malawi
Mexico
Malaysia
Mozambique
Namibia
New Caledonia
Niger
Norfolk Island
Nigeria
Nicaragua
Netherlands
Norway
Nepal
Nauru
Niue
New Zealand
Oman
Panama
Peru
French Polynesia
Papua New Guinea
Philippines
Pakistan
Poland
Saint Pierre and Miquelon
Pitcairn
Puerto Rico
Palestine, State of
Portugal
Palau
Paraguay
Qatar
Reunion
Romania
Serbia
Russian Federation
Rwanda
Saudi Arabia
Solomon Islands
Seychelles
Sudan
Sweden
Singapore
Saint Helena
Slovenia
Svalbard And Jan Mayen
Slovakia
Sierra Leone
San Marino
Senegal
Somalia
Suriname
South Sudan
Sao Tome and Principe
El Salvador
Sint Maarten(Dutch part)
Syria
Swaziland
Turks and Caicos Islands
Chad
French Southern Territories
Togo
Thailand
Tajikistan
Tokelau
Timor-Leste
Turkmenistan
Tunisia
Tonga
Turkey
Trinidad and Tobago
Tuvalu
Taiwan (Province of China)
Tanzania
Ukraine
Uganda
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vatican City State (Holy See)
Saint Vincent
Venezuela
British Virgin Islands
U.S. Virgin Islands
Vietnam
Vanuatu
Wallis and Futuna
Samoa
Kosovo
Yemen
Mayotte
South Africa
Zambia
Zimbabwe
Region
*
Address
*
Street Address
Address Line 2
City
ZIP / Postal Code
Hidden
State
*
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
International
Additional Information
Type of School/Organization
*
Church
College/University
District Office
Head Start/Early Head Start
Elementary School
Faith-Based Childcare/School
Government Agency
High School
Home School
Independent Childcare
Middle School
Pre-K
Private Childcare
Public Childcare
Other
Please Define
Hidden
Type of School/Organization
*
Church
College/University
District Office
Head Start/Early Head Start
Elementary School
Faith-Based Childcare/School
Government Agency
High School
Home School
Independent Childcare
Middle School
Pre-K
Private Childcare
Public Childcare
Emergency Cell
*
Billing Contact Information
Name of Person to Receive Invoice
*
First
Last
Organization
Billing Country
*
United States
Andorra
United Arab Emirates
Afghanistan
Antigua and Barbuda
Anguilla
Albania
Armenia
Netherlands Antilles
Angola
Antarctica
Argentina
American Samoa
Austria
Australia
Aruba
Aland Islands
Azerbaijan
Bosnia and Herzegovina
Barbados
Bangladesh
Belgium
Burkina Faso
Bulgaria
Bahrain
Burundi
Benin
Saint Barthelemy
Bermuda
Brunei Darussalam
Bolivia
Bonaire, Saint Eustatius and Saba
Brazil
Bahamas
Bhutan
Bouvet Island
Botswana
Belarus
Belize
Canada
Cocos (Keeling) Islands
Congo (Democratic Republic)
Central African Republic
Congo (Republic)
Switzerland
Cote d'Ivoire
Cook Islands
Chile
Cameroon
China
Colombia
Costa Rica
Cuba
Cape Verde
Curacao
Christmas Island
Cyprus
Czech Republic
Germany
Djibouti
Denmark
Dominica
Dominican Republic
Algeria
Ecuador
Estonia
Egypt
Western Sahara
Eritrea
Spain
Ethiopia
Finland
Fiji
Falkland Islands (Malvinas)
Micronesia
Faroe Islands
France
Gabon
United Kingdom
England
Scotland
Wales
Northern Ireland
Grenada
Georgia
French Guiana
Guernsey
Ghana
Gibraltar
Greenland
Gambia
Guinea
Guadeloupe
Equatorial Guinea
Greece
South Georgia and the South Sandwich Islands
Guatemala
Guam
Guinea-Bissau
Guyana
Hong Kong (SAR China)
Heard & McDonald Islands
Honduras
Croatia
Haiti
Hungary
Indonesia
Ireland
Israel
Isle of Man
India
British Indian Ocean Terr.
Iraq
Iran
Iceland
Italy
Jersey
Jamaica
Jordan
Japan
Kenya
Kyrgyzstan
Cambodia
Kiribati
Comoros
Saint Kitts And Nevis
North Korea
Republic of Korea
Kuwait
Cayman Islands
Kazakhstan
Laos
Lebanon
Saint Lucia
Liechtenstein
Sri Lanka
Liberia
Lesotho
Lithuania
Luxembourg
Latvia
Libya
Morocco
Monaco
Moldova
Montenegro
Saint Martin
Madagascar
Marshall Islands
North Macedonia
Mali
Myanmar
Mongolia
Macao (SAR China)
Northern Mariana Islands
Martinique
Mauritania
Montserrat
Malta
Mauritius
Maldives
Malawi
Mexico
Malaysia
Mozambique
Namibia
New Caledonia
Niger
Norfolk Island
Nigeria
Nicaragua
Netherlands
Norway
Nepal
Nauru
Niue
New Zealand
Oman
Panama
Peru
French Polynesia
Papua New Guinea
Philippines
Pakistan
Poland
Saint Pierre and Miquelon
Pitcairn
Puerto Rico
Palestine, State of
Portugal
Palau
Paraguay
Qatar
Reunion
Romania
Serbia
Russian Federation
Rwanda
Saudi Arabia
Solomon Islands
Seychelles
Sudan
Sweden
Singapore
Saint Helena
Slovenia
Svalbard And Jan Mayen
Slovakia
Sierra Leone
San Marino
Senegal
Somalia
Suriname
South Sudan
Sao Tome and Principe
El Salvador
Sint Maarten(Dutch part)
Syria
Swaziland
Turks and Caicos Islands
Chad
French Southern Territories
Togo
Thailand
Tajikistan
Tokelau
Timor-Leste
Turkmenistan
Tunisia
Tonga
Turkey
Trinidad and Tobago
Tuvalu
Taiwan (Province of China)
Tanzania
Ukraine
Uganda
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vatican City State (Holy See)
Saint Vincent
Venezuela
British Virgin Islands
U.S. Virgin Islands
Vietnam
Vanuatu
Wallis and Futuna
Samoa
Kosovo
Yemen
Mayotte
South Africa
Zambia
Zimbabwe
Billing Region
*
Billing Address
*
Same as Contact Information
Street Address
Address Line 2
City
ZIP / Postal Code
Email to Send Invoice
*
Email of Secretary
Phone of Payer
*
Event Information
Type of Event
*
Select one
Training
Coaching
Keynote
1 Hour Consultation
E-Course Facilitation
Event Dates
*
Enter as MM/DD/YYYY. To add additional dates, use the "+" (NOTE: All requests should be completed at least 60 days prior to the requested date of your training. You will need to have a training date in mind when submitting your request.)
Proposed Start Date
Proposed End Date
Hidden
Proposed Start Date
MM slash DD slash YYYY
Hidden
Date Details
Speaking Site
Site Country
*
United States
Andorra
United Arab Emirates
Afghanistan
Antigua and Barbuda
Anguilla
Albania
Armenia
Netherlands Antilles
Angola
Antarctica
Argentina
American Samoa
Austria
Australia
Aruba
Aland Islands
Azerbaijan
Bosnia and Herzegovina
Barbados
Bangladesh
Belgium
Burkina Faso
Bulgaria
Bahrain
Burundi
Benin
Saint Barthelemy
Bermuda
Brunei Darussalam
Bolivia
Bonaire, Saint Eustatius and Saba
Brazil
Bahamas
Bhutan
Bouvet Island
Botswana
Belarus
Belize
Canada
Cocos (Keeling) Islands
Congo (Democratic Republic)
Central African Republic
Congo (Republic)
Switzerland
Cote d'Ivoire
Cook Islands
Chile
Cameroon
China
Colombia
Costa Rica
Cuba
Cape Verde
Curacao
Christmas Island
Cyprus
Czech Republic
Germany
Djibouti
Denmark
Dominica
Dominican Republic
Algeria
Ecuador
Estonia
Egypt
Western Sahara
Eritrea
Spain
Ethiopia
Finland
Fiji
Falkland Islands (Malvinas)
Micronesia
Faroe Islands
France
Gabon
United Kingdom
England
Scotland
Wales
Northern Ireland
Grenada
Georgia
French Guiana
Guernsey
Ghana
Gibraltar
Greenland
Gambia
Guinea
Guadeloupe
Equatorial Guinea
Greece
South Georgia and the South Sandwich Islands
Guatemala
Guam
Guinea-Bissau
Guyana
Hong Kong (SAR China)
Heard & McDonald Islands
Honduras
Croatia
Haiti
Hungary
Indonesia
Ireland
Israel
Isle of Man
India
British Indian Ocean Terr.
Iraq
Iran
Iceland
Italy
Jersey
Jamaica
Jordan
Japan
Kenya
Kyrgyzstan
Cambodia
Kiribati
Comoros
Saint Kitts And Nevis
North Korea
Republic of Korea
Kuwait
Cayman Islands
Kazakhstan
Laos
Lebanon
Saint Lucia
Liechtenstein
Sri Lanka
Liberia
Lesotho
Lithuania
Luxembourg
Latvia
Libya
Morocco
Monaco
Moldova
Montenegro
Saint Martin
Madagascar
Marshall Islands
North Macedonia
Mali
Myanmar
Mongolia
Macao (SAR China)
Northern Mariana Islands
Martinique
Mauritania
Montserrat
Malta
Mauritius
Maldives
Malawi
Mexico
Malaysia
Mozambique
Namibia
New Caledonia
Niger
Norfolk Island
Nigeria
Nicaragua
Netherlands
Norway
Nepal
Nauru
Niue
New Zealand
Oman
Panama
Peru
French Polynesia
Papua New Guinea
Philippines
Pakistan
Poland
Saint Pierre and Miquelon
Pitcairn
Puerto Rico
Palestine, State of
Portugal
Palau
Paraguay
Qatar
Reunion
Romania
Serbia
Russian Federation
Rwanda
Saudi Arabia
Solomon Islands
Seychelles
Sudan
Sweden
Singapore
Saint Helena
Slovenia
Svalbard And Jan Mayen
Slovakia
Sierra Leone
San Marino
Senegal
Somalia
Suriname
South Sudan
Sao Tome and Principe
El Salvador
Sint Maarten(Dutch part)
Syria
Swaziland
Turks and Caicos Islands
Chad
French Southern Territories
Togo
Thailand
Tajikistan
Tokelau
Timor-Leste
Turkmenistan
Tunisia
Tonga
Turkey
Trinidad and Tobago
Tuvalu
Taiwan (Province of China)
Tanzania
Ukraine
Uganda
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vatican City State (Holy See)
Saint Vincent
Venezuela
British Virgin Islands
U.S. Virgin Islands
Vietnam
Vanuatu
Wallis and Futuna
Samoa
Kosovo
Yemen
Mayotte
South Africa
Zambia
Zimbabwe
Site Region
*
Site Address
*
Same as Contact Information
Street Address
Address Line 2
City
ZIP / Postal Code
What is the most convenient airport to fly into?
Describe the Event
Hidden
Type of Audience
*
Please select all that apply
Administration
Administration – Childcare
Administration – Elementary School
Administration – Middle School
Administration – High School
Assistant Director
Before/After School Care
Behavior Specialist/Interventionist
Bilingual/Spanish
Center Director
Childcare Provider
Classroom Aide
Classroom Coach
Counselor/Mental Health Professional
Director
Disabilities Specialist
Disabilities Manager
District Office
Education Manager
Education Specialist
Family Engagement Staff
Family Engagement Manager
Foster Care Organization/Non-Profit Organization
Health Specialist
Health Manager
Home Visitor
Human Resources Specialist
Non-Profit Organization
Lead Teacher
Legislature/Government Official
Mental Health Professional/Specialist
Middle School (6th – 8th)
High School
Office of Education or other State Level
Paraprofessional
Parent
Parent/Family Involvement
Private Preschool/PreK
Program Director
Psychology
Public Preschool/PreK
Resource Teacher
Social Emotional Learning Coordinator/Administrator
Social Work
Special Needs
Specialist (PE, Music, Art, etc)
Student
Superintendent or other District Level
Teacher
Teacher – Art/Music/Specialist
Teacher – Infant/Toddler
Teacher – Preschool/Childcare
Teacher – Kindergarten
Teacher – Elementary School
Teacher – Upper Elementary
Teacher Aide
Teacher Assistant
Therapist (Occupational, Speech, Physical)
Other Not Listed
Hidden
Type of Audience
Please select all that apply
Administration
Teachers
Mental Health
Support Staff
Family Engagement
Parents
District Staff
State/Federal Government
Other
Type of Audience
*
Administration
Teachers
Mental Health
Support Staff
Family Engagement
Parents
District Staff
State/Federal Government
Other
Please describe
*
Hidden
Age Group of Children
Please select all that apply
Select All
Infant/Toddler
Pre-K/K
Elementary
Jr. High
High School
Administration/Staff
Other Not Listed
Age Group of Children
*
Infant/Toddler
Pre-K/K
Elementary
Jr. High
High School
Administration/Staff
Others Not Listed
Please Describe
*
Hidden
Estimated Number in Attendance
Estimated Number in Attendance
*
Start Time
*
:
Hours
Minutes
AM
PM
AM/PM
End Time
*
:
Hours
Minutes
AM
PM
AM/PM
Time Zone
*
I need to
Request another type of event.
Hidden
Event Information - #2
Hidden
I have been working with the following speaker
Type of Event
*
Select one
Training
Coaching
Keynote
1 Hour Consultation
E-Course Facilitation
Hidden
Event Dates
*
Enter as MM/DD/YYYY. To add additional dates, use the "+"
Proposed Start Date
Proposed End Date
Hidden
Speaking Site
Hidden
Site Address
*
Same as Contact Information
Street Address
Address Line 2
City
ZIP / Postal Code
Hidden
Describe the Event - #2
Hidden
Type of Audience
*
Please select all that apply
Administration
Administration – Childcare
Administration – Elementary School
Administration – Middle School
Administration – High School
Assistant Director
Before/After School Care
Behavior Specialist/Interventionist
Bilingual/Spanish
Center Director
Childcare Provider
Classroom Aide
Classroom Coach
Counselor/Mental Health Professional
Director
Disabilities Specialist
Disabilities Manager
District Office
Education Manager
Education Specialist
Family Engagement Staff
Family Engagement Manager
Foster Care Organization/Non-Profit Organization
Health Specialist
Health Manager
Home Visitor
Human Resources Specialist
Non-Profit Organization
Lead Teacher
Legislature/Government Official
Mental Health Professional/Specialist
Middle School (6th – 8th)
High School
Office of Education or other State Level
Paraprofessional
Parent
Parent/Family Involvement
Private Preschool/PreK
Program Director
Psychology
Public Preschool/PreK
Resource Teacher
Social Emotional Learning Coordinator/Administrator
Social Work
Special Needs
Specialist (PE, Music, Art, etc)
Student
Superintendent or other District Level
Teacher
Teacher – Art/Music/Specialist
Teacher – Infant/Toddler
Teacher – Preschool/Childcare
Teacher – Kindergarten
Teacher – Elementary School
Teacher – Upper Elementary
Teacher Aide
Teacher Assistant
Therapist (Occupational, Speech, Physical)
Other Not Listed
Hidden
Please describe
Hidden
Age Group of Children
*
Please select all that apply
Select All
Infant/Toddler
Pre-K/K
Elementary
Jr. High
High School
Administration/Staff
N/A
Other Not Listed
Hidden
Please Describe
*
Hidden
Estimated Number in Attendance
*
Hidden
Start Time
*
:
Hours
Minutes
AM
PM
AM/PM
Hidden
End Time
*
:
Hours
Minutes
AM
PM
AM/PM
Hidden
Time Zone
*
Additional Information
CI attend
Any Conscious Discipline Certified Instructors within the area may attend and participate by observation at this training.
Quote
I have received a price quote for this training.
How did you hear about us?
Returning Customer
ASCD Conference
Title 1 Conference
NAEYC Conference
NAESP Conference
NAEYC Professional Development Conference
Online
Other
Please describe
Any additional information that we should know?
CAPTCHA
Δ