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	Thank you for your interest in the Essential Elements of Adult Drug Courts Course. Please complete and submit the form to request enrollment in the course.

1.	First Name:*

2.	Last Name:*

3.	Name of Court or Organization:*

4.	Your Position Title:*

5.	Email Address:*

6.	Phone Number:*

7.	Indicate which best describes your court:*
	Planning  Implementing  Operational 0-6 months  Operational 6-12 months  Operational 1-2 years   Operational for more than 2 years

8.	Specify the area your drug court serves/will serve:*
	Suburban  Rural  Urban  Native American   Other, please specify:

9.	When did your drug court begin operating (Month/Year)?*

10.	When did/will you begin working in drug court (Month/Year)? *

11.	Have you attended other formal drug court training?*
	Yes  No   If yes, please specify what and when: