Gang Task Force

Youth Service Worker Training

Date: (mm/dd/yy)

Agency, district, etc.:

Contact Person:

Telephone:         Extension:

Email:

Specific Areas of Concern/Interest:

Number of workers expected to attend:

Possible dates and or times (before end of 2005-2006 school year):

Do you have a room available for all attending the event:  Yes No

Seating capacity:

Any other comments: