1.	Which training topics interest you? (Check all that apply)* (To learn more about these training topics, please visit our services page)
	Career Development    Disability Services    Employer/Corporate Support for Employees with Disabilities    Succession Planning    Certificate Series: Job Coach/Supported Employment    Continuing Education (M.S. in Rehabilitation Counseling)    Transition Planning    Organizational Development    Other, please specify

2.	Please rate your training format preferences.* (1 is the least preferred and 5 is the most preferred)
	1 - least preferred   2   3 - neutral   4   5 - most preferred Traditional Classroom Style           Conference           Teleconference           Online Course

3.	How does your employer encourage professional development?*
	My employer provides professional development for the staff on site, as needed My employer sends me to professional development at my request and pays for it My employer sends me to professional development at my request, but the fees are my responsibility Other, please specify

4.	What type of professional development requirements are there for your career, certification, and/or licensure?*
	Certified Rehabilitation Counselor (CRC)    Teacher/School Administrator Certification    I have no requirements in my field    Other, please specify

5.	What is your role?*
	Parent or Family Member    School Faculty or Staff    Service Provider    State Agency    Employer

	Optional Questions

6.	If you would like to be contacted regarding your training needs, please enter your contact information below. (Name, Organization, Phone Number, Email Address)

7.	Any additional comments or questions?