Attn: /Dorothy Paugh/ Ti-Anna May

Fax: 301-763-6831

Phone: 301-763-2058, [dorothy.j.paugh@census.gov]{.underline} or

Phone 301-763-2132, [ti.anna.m.may@census.gov]{.underline}

To request training from the U.S. Census Bureau, please answer the
following questions and fax or email this form to Dorothy Paugh or
Ti-Anna May. Please make your request a minimum of two months prior to
your proposed date. Be advised for groups less than 10, we offer only
videoteleconference (VTC) training. Onsite training requires two Census
Bureau instructors -- please specify what travel expenses your group can
cover for those instructors.

Name of contact person:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Job Title:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ E-mail
address: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Phone number: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Fax
number: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Organization:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

City: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ State:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Organization's website:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (so we
can learn more about your needs)

Type of training requested: \_\_\_\_\_\_\_ Lecture and online demos
\_\_\_\_\_\_\_\_ Videoteleconferencing (VTC)

\_\_\_\_\_\_\_\_ Hands-on using internet and computers

How many participants do you anticipate? \_\_\_\_\_\_\_\_ 1-10 (VTC
only) \_\_\_\_\_\_\_ 10-25 \_\_\_\_\_\_\_\_\_25+

What is your group's level of knowledge about Census Bureau data?

\_\_\_\_\_Beginner \_\_\_\_\_\_Intermediate \_\_\_\_\_\_\_Advanced

What type of Census Bureau data does your group regularly use?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Please rank the following potential topics in order of need (1
indicating the highest need, and 7 indicating the lowest need):

\_\_\_\_\_Census 2010

\_\_\_\_\_About Data Concepts and Products

\_\_\_\_\_All about Economic Data

\_\_\_\_\_Geography: The Backbone of Census Bureau Data

\_\_\_\_\_Finding Data

\_\_\_\_\_The Census Bureau's Newest Product: Local Employment Dynamics

\_\_\_\_\_The New Long Form: The Annual American Community Survey

\_\_\_\_\_Using the Census Bureau's Data Tool: American FactFinder

Other (specify):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

What is your specialty need, i.e., housing, workforce, children?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Potential date(s) of requested training:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Length of requested training: \_\_\_\_\_4 hours \_\_\_\_\_6-8 hours
\_\_\_\_\_1.5 days \_\_\_\_\_2 days

Location and venue where training would be held:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

My organization will provide: \_\_\_\_\_PC/laptop \_\_\_\_\_Multimedia
projector \_\_\_\_\_Internet-accessing computers for each student (Check
all that apply)

My organization will provide the following for two speakers:
\_\_\_\_\_Transportation \_\_\_\_\_Food \_\_\_\_\_Lodging Other
(specify):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(Check all that apply)

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