CYFAR Virtual Summit Registration Form

Competency & Capacity Building Virtual Summit:

Evidence-based Practices and Strategies for Working with Vulnerable Populations

Competency & Capacity Building Virtual Summit:

Evidence-based Practices and Strategies for Working with Vulnerable Populations

Registrant Information

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First Name:
Last Name:
Email:
Telephone:
State:
Zip Code:	(Please enter the zip code from where you will be viewing the conference.)
Organization/University Affiliation:
Position/Title:
Highest Level of Education:
Facebook Identity:
Twitter Identity:

Team or Individual Participation:	You may participate in the Virtual Summit as an individual or as a team logging in from a single computer. It helps our planning if we know how you plan to participate. We encourage team participation: it can enrich the live learning experience and add momentum to collaboration following the Summit. Participate as a individual Host a team logging in from 1 computer If participating as a team, enter the number of participants including yourself.

Will you require accommodations to participate in the Virtual Summit?	No Yes
If yes, please explain your needs:

Sessions Attending

I plan to participate in the following sessions:

Growing Up Poor - Implications & Outcomes (Sep 14 1:00-4:30 EDT)
Economic Stress for Youth and Families (Sep 15 1:00-4:30 EDT)
Inclusive Programming - Reaching Out to the Whole Community (Sep 16 1:00-4:30 EDT)


My areas of interest include:	Education Health Community Education Corrections Mental Health Social Services Youth Work/Out-of-School Working with At-Risk or Vulnerable Populations Evidence-based Strategies Program Models Evaluation or Applied Research Parenting and Parenting Education Couples and Relationship Education Diversity and Cultural Competence Other

Check if you are faculty/staff member or a collaborator of:	CYFAR Program Extension Federal grant-funded program Other

How did you hear about the Virtual Summit?	Received summit brochure or postcard Email to a listserv E-newsletter Website From blog, Facebook, Twitter, or RSS feed Announced at other conference or meeting Forwarded by a colleague Other