2. 

4. Westmoreland County Behavioral Health and Developmental Services Program office is committed to supporting adults, children, and families living with a behavioral health and/or a developmental disability to live a full and rewarding life. We seek to partner year round with our providers and community organizations to raise awareness about these issues and to provide education and resources about the valuable services in our county. We are able to set up a table to share county resources and service information, to provide trainings on the involuntary commitment process, to provide trainings on the continuum of care, etc.

   If you are hosting an outreach or educational event and would like to have someone from our office come to your organization/event for training or speaker services, we are requesting that the Event and Training Request form be completed and returned to our office at least two weeks prior to the scheduled event. Upon receipt, our office will contact you to discuss your training/event request and to confirm our participation.

   If possible, please submit your event/conference/training flyer or brochure along with the request.

6. Name of Organization*
8. Contact Name:*
10. Email:*
11. Phone:*
13. Request for:

    1. Speaker / Trainer

    1. Event (seeking vendors)
15. Event Title:*
17. Event Date:
    Event Date:
18. Start and End Time:
    Start and End Time: Start Time

    —

    Start and End Time: End Time
20. Event Location:
22. Brief description of event:
24. Brief description what you need from our office:
26. Is there a cost to set up a table?

    For conferences/public events only.

    1. Yes

    1. No
27. How many people are expected to attend?
29. Who are the intended participants?

    1. Adults

    1. Older Adults

    1. Children

    1. Families
31. For trainings or speaker service requests:

    Please provide a brief description of the type of training you are seeking and the length of time that the speaker will have.

33. For ALL requests.

    The event/training topic will focus on:

    1. Adult BH
    2. Children's BH

    1. EI (birth to 3 years)
    2. ID/D

    1. Autism / ASD
35. Notes/Special Considerations:
37. Upload your event/conference/training flyer or brochure.
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field