STAR Service Request Form

( * ) Required field

Contact Information

Purchasing Information

Are you authorized to make purchases for your organization?
Yes No
If not, who is the point of contact for procurements?
Name:
Phone Number:
Email Address:
Mailing Address:

Package Selection and Scheduling

Requested Training Package: (Indicate the number of packages requested. Additional packages are not guaranteed.)
Option I Option IIHow Many?
Have you reviewed the additional costs associated with the training packages? This information is available at www.startoolkit.org/addexpense.html.
Yes No
Do you agree to support the additional costs associated with the training packages?
Yes No
Start Date:
Fall 2007 Fall 2008
What are the programs’ class schedules (e.g., September- June, year round)?

Participants

Number of Participants: (Training packages serve up to 45 people. If a state/program wishes to train more than 45 people, they must buy two or more packages.)
Will these 45 participants represent multiple program sites?
Yes No
If yes, list the names of program sites.
1. 2. 3. 4. 5.
What process was used to select local program sites?

Have the program sites received information about STAR?
Yes No
If so, please describe the nature of this information.

Readiness

Do any of these sites operate using managed enrollment policies?
Yes No
If so, list program site(s).

Do any of these programs have leveled classes?
Yes No
If so, list program site(s).

Have you thoroughly reviewed the “Ready for STAR?” section of the web site?
Yes No
If so, what questions do you have related to state and/or local program readiness?

State Leadership

Have you assembled a STAR leadership team?
Yes No
If so, identify team members and titles.

Follow-up

Who would be the point of contact for future inquiries (e.g., to gather additional information or to schedule training)?

How did you learn about STAR?

Please note any details that may be helpful in the site selection process.

* I understand that by submitting this Service Request Form I am committing to the purchase of the STAR training package selected above.