2020 PBIS TLC Institute, Tier 2/3
A 5-Day PBIS Trainer-Leader-Coach (TLC) Trainer-of-Trainer (TOT) Training to become a Certified PBIS Tier 2/3 Trainer
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Welcome - June 22-26, 2020 in Phoenix, AZ
Participant's District *
Complete name of your district or governing body, no abbreviations please
Participant's School *
Complete name of your school, no abbreviations please
Participant's First + Last Name *
List the name you commonly use
Participant's Job Title *
List your job title or position
Participant's Work Email *
JaneDoe@abcschool.org - pre-reading and digital books will be emailed to this address
Participant's Alt. Email *
JaneDoe@gmail.com - participate in the PBIS professional learning community
Participant's Cell 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 *
Phone number of the person sending the PO or responsible for payment
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
TLC Institute *
By checking the box, I acknowledge the following: 1) I meet the pre-requisite skills, have experience implementing PBIS for at least 1+ years, have knowledge and background in behavior interventions, and have training and coaching skills/disposition, 2) I will receive an iPad, digital iBooks and participate in all 5-days of training (including pre-reading,  reading research material and completing all activities) in order to receive a certificate for 30 hours of professional development training, 3) I agree to submit the registration fee immediately to secure my seat.
Required
Participant Agreement *
By checking the box, I acknowledge that before receiving training, I will need to sign a Participant Agreement (license agreement) and will use the KOI Education licensed training materials and curriculum solely for my School or District’s internal operational purposes.
Required
Training Curriculum *
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. Additional KOI PBIS books (digital or physical) need to be purchased for each person attending your training.
Required
Conference Registration *
By checking the box, I acknowledge that my seat is not confirmed until registration is paid in full. If I need to cancel registration I will email a request to info@koi-education.com no later than 90 days prior to the start of training. The registration fee, less a 25% administrative fee, will be refunded for registrations cancelled 90 days before the start of training.  No refunds can be issued less then 90 days prior to training, however, registration is transferable so a substitute may be sent in my place.
Required
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