Once a program is confirmed with a speaker, this form is to be sent to the SSW/AHEC Liaison with the details of the program. This form is very helpful to the SSW/AHEC Liaison in keeping track of confirmed programs.
[form]
AHEC Confirmed Training: _____________________________________________________________
AHEC Contact Person: _________________________________________________________________
Location of Training (include County): ____________________________________________________
SSW/AHEC Training Faculty/Consultant Confirmed: ____________________________________________________________________________________
Confirmed Program Title: _______________________________________________________________________
Date of Confirmed Program: ____________________________________________________________________________________
____________________________________________________________________________________
Number of Contact Hours: ______________________________________________________________
Format (Virtual/Hybrid/In-Person): ________________________________________________________
Other Important Details: