June 10, 11, _ , 13, 14, 2024 
Certified PBIS Online Tier 1 Course - 4-Days, plus pre-reading
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Participant's District *
Complete name of your district or governing body, no abbreviations please.
Participant's School *
Complete name of your school, if applicable, no abbreviations please.
Participant's First + Last Name *
List the name you commonly use.
Participant's Work Email *
JaneDoe@abcschool.org - pre-reading and digital books will be emailed to this address.
Participant's Job Title *
List your job title or position.
Participant's Mailing Address *
Work or personal address where you would like to receive course materials.
Participant's Cell Phone Number *
602-123-4567 - this helps us contact you in case of an email glitch.
Supervisor/District Representative First + Last Name *
Person authorized to sign the curriculum Participation Agreement on behalf of the district/organization.
Supervisor/District Representative Email *
Email of person authorized to sign the curriculum Participation Agreement on behalf of the district/organization.
Supervisor/District Representative Phone Number *
602-123-4567 - this helps us contact you in case of an email glitch.
Billing Contact First + Last Name *
List the name of the person sending the PO or responsible for payment.
Billing Contact Email *
Email of the person sending the PO or responsible for payment so we can send an invoice.
Billing Contact Phone Number *
602-123-4567 - this helps us contact them in case of an email glitch.
PO Number
Purchase Order Number. Send PO to info@koi-education.com. Registration is confirmed after PO is received and invoice is paid in full. Please share this information with your Billing Contact person.
Pre-requisites *
By checking the box, I acknowledge that I meet the pre-requisite skills: 1) have experience implementing PBIS for at least 1+ years, 2) I have knowledge and background in behavior interventions, 3) I have training and coaching skills/disposition, 4) I will participate in all scheduled days of training and complete all pre-reading and course activities in order to receive a certificate for professional development CEU's.
Required
License Agreement *
By checking the box, I acknowledge that before beginning this course, participants and a district representative must sign a License Agreement allowing the use the KOI Education licensed training materials and curriculum solely for my School or District’s internal operational purposes.
Required
PBIS Curriculum & Books *
By checking the box, I acknowledge that PBIS TLC graduates will be given exclusive license to use KOI PBIS Curriculum, presentation slides, and training materials. KOI PBIS Manuals (digital or physical) will need to be purchased for each person attending my training. Books are available at https://www.koi-education.com/books, or from Amazon and AppleBooks.
Required
Course Registration *
By checking the box, I acknowledge that my seat is not confirmed until registration is paid in full. Cancelations must be received in writing at least 90 days prior to the course for a full refund, 60 days for a half refund, and 30 days for partial refund. A substitute may be assigned in my place but must register 30 days or more prior to the course. Email info@koi-education.com with substitute information and refund request.
Required
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