AA #4067 Registration Form

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We are glad you will join us this year! Please use this form for single registrations. If you'd like to register a group, please use this sheet and share/send to Matt Weld > mweld@roe3.org.

June 4, 2024 from 9:00 - 3:00 at the Gateway Center in Collinsville, IL. Lunch on your own. 5 PD Hours or AA credit that we can apply to FY24 or FY25.

The event is free, paid for by funds from the ISBE Area 5 SEL Hub Grant and the Project AWARE Grant.

Last Name *

First Name *

Email Address *

Your Regional Office of Education (ROE) or Intermediate Service Center (ISC) *

If you are not employed in Illinois, please put your state under 'Other'

ROE #1 (Adams, Brown, Cass, Morgan, Pike, and Scott Counties)

ROE #3 (Bond, Christian, Effingham, Fayette, and Montgomery Counties)

ROE #4 (Boone and Winnebago Counties)

ROE #8 (Carroll, Jo Daviess, and Stephenson Counties)

ROE #9 (Champaign and Ford Counties)

ROE #11 (Clark, Coles, Cumberland, Douglas, Edgar, Moultrie, and Shelby Counties)

ROE # 12 (Clay, Crawford, Jasper, Lawrence, and Richland Counties)

ROE #13 (Clinton, Jefferson, Marion, and Washington Counties)

ROE #16 (DeKalb County)

ROE #17 (Dewitt, Livingston, Logan, and McLean Counties)

ROE #19 (DuPage County)

ROE #20 (Edwards, Gallatin, Hamilton, Hardin, Pope, Saline, Wabash, Wayne, and White)

ROE #21 (Franklin, Johnson, Massac, and Williamson Counties)

ROE #24 (Grundy and Kendall Counties)

ROE #26 (Fulton, Hancock, McDonough, and Schuyler Counties)

ROE #28 (Bureau, Henry, and Stark Counties)

ROE #30 (Alexander, Jackson, Perry, Pulaski, and Union Counties)

ROE #31 (Kane County)

ROE #32 (Iroquois and Kankakee Counties)

ROE #33 (Henderson, Knox, Mercer, and Warren Counties)

ROE #34 (Lake County)

ROE #35 (LaSalle, Marshall, and Putnam Counties)

ROE #39 (Macon and Piatt Counties)

ROE #40 (Calhoun, Greene, Jersey, and Macoupin Counties)

ROE #41 (Madison County)

ROE #44 (McHenry County)

ROE #45 (Monroe and Randolph Counties)

ROE #47 (Lee, Ogle, and Whiteside Counties)

ROE #48 (Peoria County)

ROE #49 (Rock Island County)

ROE #50 (St. Clair County)

ROE #51 (Sangamon and Menard Counties)

ROE #53 (Mason, Tazewell, and Woodford Counties)

ROE #54 (Vermillion County)

ROE #56 (Will County)

ISC - North Cook

ISC - South Cook

ISC - West 40

Other…

School District *

Your role in the district *

Teacher

Paraprofessional

Counselor/Social Worker/Mental Health

Administrator

Instructional/Tech/SEL Coach

Other:

Anything else we need to know?

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