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Piedmont Triad Regional Council, NC
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PTRWDB Mobile Unit Request Form - WDB
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Workforce Development
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About the Workforce Development Board
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Board Membership
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Newsletter Edition III, May 2019
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PTRWDB Mobile Unit Request Form - CBO
PTRWDB Mobile Unit Request Form - WDB
PTRWDB Mobile Unit Request Form - PTRC
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2019 Piedmont Triad Talent & Workforce Summit
Please correct the field(s) marked in red below:
Entity Name
*
Entity Name
Contact Name
*
Contact Name
Contact Title
*
Contact Title
E-mail
*
E-mail
Phone
*
Phone
ext.
County
County
Municipality
Municipality
Event Type
Event Type
Business Services
Job Fair
Plant Closing
Courtesy Visit
Mobile Unit Operator Training
Other, Please Explain
If other, type text here.
Date(s) for Event
*
Date(s) for Event
Event Location - Please provide the name and address of where the unit is needed.
*
Event Location - Please provide the name and address of where the unit is needed.
Name of contact person at the event.
*
Name of contact person at the event.
Cell phone number for the contact person (for day of event).
*
Cell phone number for the contact person (for day of event).
Date/Time of Arrival
Date/Time of Arrival
Date/Time of Departure
Date/Time of Departure
Facilities
Are public toilet facilities available?
(Note: If not, scheduling entity will be responsible for providing portable facilities.)
Are public toilet facilities available? (Note: If not, scheduling entity will be responsible for providing portable facilities.)
Yes
No
Is secured onsite storage available for the PTRWDB Unit?
Is secured onsite storage available for the PTRWDB Unit?
Yes
No
Staff assistance is available?
Staff assistance is available?
Yes
No
Additional Notes:
Additional Notes:
Request Submitted by:
*
Request Submitted by:
YES, I’ve read the PTRC Rover Policies and Procedures and understand the Fees associated with my group or organization.
*
YES, I’ve read the PTRC Rover Policies and Procedures and understand the Fees associated with my group or organization.
To receive a copy of your submission, please fill out your email address below and submit.
Email Address
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