Community Programs Pre-NCJSA Conference
October 23-24, 2017
Registration Form
DPS’s Juvenile Community Programs works to be responsive to the needs of our partners in the community and has joined forces with the NCJSA Board of Directors to offer two days of pre-conference training specifically designed to meet the needs of our JCPC-funded program providers. There is no registration fee required for our program provider participants! We hope that this two-day training directly affords professional growth for our providers and ultimately positive outcomes for those youth and families served but space is limited and participants must register for the event. Here is what is provided with your registration during the two-day event.: (1) An opportunity to participate in your choice of trainings from a menu of 12 workshops; (2)Two continental breakfasts, on Monday and Tuesday mornings (3) Two luncheons—one of which will offer a “lunch and learn” opportunity. Dinners are on your own. Overnight accommodations may be reserved the Courtyard Marriott for Sunday and Monday nights at the NC state rate and the Courtyard Marriott has graciously offered to extend hotel registration stays for those that wish to continue their stay for the NCJSA Fall Conference. (Some scholarships are available for this two-day event to assist with overnight stays based on need.) Registration limited to 2 participants per sponsoring agency.
Submit registrations to.
(Please Print or Type)Today’s date:
SPONSORING agency INFORMATION
First Name: / Last: / Middle: / Title:
Sponsoring Agency:
Program Name: / County of Program Location:
Email: / Telephone:
P.O. Box: / City: / State: / ZIP Code:
Arrival Dates:
Sunday: October 22, 2017 ☐
Monday: October 23, 2017 ☐ / Number of Nights Stay at the Courtyard Marriott:
Sunday: Yes☐ No☐
Monday: Yes ☐ No☐
I am a commuter and will be participating on the following days:
Monday: Yes ☐No☐Tuesday: Yes ☐No ☐
Tuesday: October 24, 2017 ☐
ncjsa INFORMATION
Attending NCJSA CONFERENCE:
Yes:☐No: ☐
Limited scholarships are available for Sunday and/or Monday night accommodations at the Courtyard Marriott at Carolina Beach for this pre-conference training event. Please complete the following scholarship request for accommodations only. Registration for the event includes 2 days continental breakfast; 2 lunches and preconference workshop trainings. Dinners and travel costs are the responsibility of the participant. Please provide the basis of your need via this registration. Your Area Consultant will advise upon award of scholarships. Scholarship accommodations are limited to one room reservation (for 1 or 2 nights) per provider. (Rooms may accommodate for up to two pre-conference participants.) Please indicate the following need:
Partial attendance:
I will be arriving on Sunday, October 22nd and will need 1 night (Sunday) accommodations: ☐
I will be arriving Monday, October 23rd and will need 1 night (Monday) accommodations:☐
Full attendance:
I will be arriving on Sunday October 22nd and will need 2 nights (Sunday and Monday) accommodations: ☐
Scholarship request to assist with overnight accommodations: Please state your need and submit with the completed registration form. Your Area Consultant will notify to confirm your hotel reservation (s). Please indicate if there will be shared accommodations with another colleague from your agency and indicate full names of participants.
Submit registrations to