JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Online Course
The Parent Academy Online Course is made available for free through the Center for Excellence in Literacy Instruction (CELI) at the University of Mississippi. We appreciate you completing this questionnaire to support the funding for this resource and other services. Your information won't be used for outside solicitation and will remain private.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
What is your full name?
*
Your answer
What is your address? (city, state, zip)
*
Your answer
Please list the number and ages of children for whom you are taking this course.
*
Your answer
What is your role for the children above?
*
Parent
Grandparent/Other family member
Guardian
Caregiver/Childcare
Teacher
Association with a specific school or organization
Other:
Required
How did you hear about this course?
*
Your answer
I am interested in taking this course:
*
by myself through this website. (A link will be provided after you submit this form. It may appear blank after you submit, so be sure and scroll to the top of the page.)
with a group, facilitated by an instructor. Groups or cohorts can include families, as well as their children, and educators or other professionals who serve families and children. (Someone will contact you.)
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of The Farthest Pixel.
Does this form look suspicious?
Report
Forms
Help and feedback
Help Forms improve
Report
