2024 Pacific Rim Pre-Conference Registration Name:(Required) First Last Email:(Required) Enter Email Confirm Email Organization:(Required) State/Territory:(Required)AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAmerican SamoaBureau of Indian AffairsFederated States of MicronesiaGuamNorthern Mariana IslandsPuerto RicoRepublic of PalauRepublic of the Marshall IslandsVirgin IslandsOtherOther State/Territory: Do you need any accommodations?(Required) Yes No Please describe accommodations needed below:Preferred name for name badge:(Required) Would you like your pronouns listed on your name badge?(Required) Yes No Please list your preferred pronouns:(Required)Choose OneHe, Him, HisShe, Her, HersThey, Them, TheirsZe, Zir, ZirsOtherOther: Which areas would you like your program to improve upon (service delivery and outcomes)? (Rank order top three/Select three)(Required) Career Pathways Employer Engagement/Employer Support Strategies Job Accommodations Rapid Engagement Self-Employment Rural and remote services Other Other areas where you would like your program to improve: In the areas where you would like your program to improve, please indicate what you think is needed to help facilitate this process (Check all that apply):(Required) Develop vocational rehabilitation (VR) policies and procedures Develop fees/rates for the service Formal collaboration with other state and/or territory partners (MOU/MOA development or similar) Staff development/training Other Other: If an opportunity to connect regularly to share policy, practice, and related resources with other VR programs in the Pacific Rim region were available, would you participate?(Required) Yes No I don’t know Approximately how many individuals from your agency would likely participate in the pre-conference (please include yourself in the attendee count)?(Required) Are there agencies that you collaborate with that you would like to invite to attend the pre-conference?(Required) Yes No If yes, please provide contact information for those agencies (agency name, contact person, contact person email).
