Back to School 2020 Registration

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Please complete the following registration form. Upon completion, you will receive the registration link for the first workshop in the series, Documenting Your Child's Regression During COVID-19. If you have any questions, please contact Jennifer Sibley at (315)785-8703. This workshop series is brought to you in collaboration with NRCIL, Families Together in New York State and Starbridge.

My name is *

What county do you live in? *

I am a ... *

Parent

Professional

Youth (Ages 14-24)

Other:

Email address *

Phone number *

If you are a parent of a child with a disability, how old is your child? (May select multiple if you have more than one child) *

I am not a parent of a child with a disability

0-2 years old

3-5 years old

6-11 years old

12-14 years old

15-18 years old

18+ years old

I choose not to answer this question

Required

If you are a parent of a child with a disability, does your child have a Committee on Special Education Classification(CSE) on their Individualized Education Plan (IEP)? (May select multiple if more than one child) *

I do not have a child with a disability

Autism

Blind

Deaf-Blind

Emotional Disturbance

Intellectual Disability

Hearing Impairment

Multiple Disabilities

Orthopedic Impairment

Other Health Impairment

Specific Learning Disability

Speech Language Impairment

Traumatic Brain Injury

Visual Impairment

Preschool Student with a Disability

Section 504 Plan

I choose not to answer

Required

My race is best described as *

Asian

Black/African American

Caucasian/White

Hispanic

Native American

Pacific Islander

Mixed Race/Two or More Races

I choose not to disclose my race

My ethnicity is best described as... *

Hispanic

Non-hispanic

I chose not to disclose my ethnicity.

I heard about this series through... *

Social Media (Facebook, Twitter, etc.)

Posted flyer

Mentioned at a conference I attended

Word of mouth/from a friend or co-worker

Other:

I would like to attend ... *

August 11: Documenting Educational Gains or Regression During COVID-19

August 18: School Anxiety and Avoidance During COVID-19

August 24: Bridging Perspectives

Required

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