If you are planning to use YDSI copyrighted materials in a training or professional development presentation, please fill out and submit the form below.

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Youth Development Strategies, Inc. Administrative Office 4 Kosco Court Hamilton, NJ 08610

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• indicates required information Name: • Title or Position: • Organization contact person: • Mailing address:   City: State: Zip: Phone number: • E-mail address: • Fax number: Web site (if available): Date you plan to use the information: Specific YDSI material you wish to use: Describe in space provided: 1) Purpose of the presentation; 2) how will you use the YDSI material; 3) what do you hope your audience will learn about the YDSI material presented? Check here if you wish to have a YDSI researcher call you about your proposed use of the YDSI material or other questions about YDSI research.   If you wish to contact YDSI please call 609.838.2636 or e-mail info@ydsi.org

	email:  info@ydsi.org phone:  609.838.2636 fax:  609.581.1578	Youth Development Strategies, Inc. 4 Kosco Court Hamilton, NJ 08610