DDN Education Scheduling Request

Please complete & submit

General Information Section

Name:
Phone:
Site or School:
Address:
City:
State:
Zip:
Email Address:
Program Category:

Please select the one category that best describes this program and target audience.

 

***Please indicate the number of participants at each site***

Example: 

Origination Site: Mitchell, 3 Remotes Site: Sioux Falls, 2;Yankton, 5
Origination Site:
Remote Sites:

Program Title:

 

 

Complete this section for 1 Time 
Program Scheduling

Program Date:
Program Start Time:

(Central Time Zone)
Program End Time:

(Central Time Zone)

Go to bottom of page and press Submit Button

Complete This Section for Reoccurring 
Program Scheduling

Program Start Date:
Program End Date:
Program Start Time:

(Central Time Zone)
Program End Time:

(Central Time Zone)
Please Enter ALL of the 
Dates and Times of  
This Reoccurring Program:

(i.e. daily M-F or every Tuesday or M,W and F)
 

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