Conflict Resolution Education - National Criminal Justice Reference ...

Appendix G: Conflict Resolution Staff
Development Provider Assessment
Forms
General Information
Provider Assessment Form
Name of provider: __________________________________________________________________
Organizational affiliation: ____________________________________________________________
Provider address:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Phone: (_____)_____________________________________________________________________
Fax: (_____)_____________________________________________________________________
Training based on specific published materials? ❑ Yes ❑ No
If yes, title of materials: ___________________________________________________________
Authors: _______________________________________________________________________
Publisher and publication date: ____________________________________________________
Materials included in training costs? ❑ Yes ❑ No
If no, cost: Teacher materials: $ __________
Student materials: $ __________ Required? ❑ Yes ❑ No
Video materials: $ __________ Required? ❑ Yes ❑ No
Other materials: $ __________ Required? ❑ Yes ❑ No
G–1