Certified Facilitator Order Form

Certified Facilitator Order Form

Please be sure to submit this form a minimum of three weeks ahead of your online course start date. Please submit a new form for each cohort you will be facilitating.
Certified Facilitator Information
Certified Facilitator Name*

First NameLast Name
Certified Facilitator Email*

Confirmation Email
Phone Number*
Please enter a valid phone number.
Sponsoring Education Organization*
Please list your sponsoring organization (e.g., ESC, BOCES, RESA, IU, CESA, SST, School District, School Name)
Co-Certified Facilitator Name(s) (If applicable)
Cohort information

Please provide the following information for your cohort:
District/School Being Trained*
IT Department Contact*

First NameLast Name
IT Department Contact Email*
example@example.com
Online Course Start Date

The recommended start date is one day before the first facilitated session. Participants will receive access to the online course on the date you choose.
Online Course Start Date*

MonthDayYear
Must be minimum 3 weeks from submission of form
Materials Needed:

Please note: You must be certified in the topic you wish to order materials for. Orders placed for other topics you are not certified to facilitate will not be processed. Only one topic can be ordered at a time. You can use the same purchase order for multiple orders. Please attach it for each.
Please select the topic you are facilitating and the quantity of licenses/manuals you will require. *
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Keys to Beginning ReadingRegistration fee for Keys to Beginning Reading CF training (includes online course, training book, and shipping)
$350.00 Quantity
Item subtotal:$0.00



Key Comprehension RoutineRegistration fee for The Key Comprehension Routine CF training (includes online course, training book, and shipping)
$210.00 Quantity
Item subtotal:$0.00



Key Vocabulary RoutineRegistration fee for The Key Vocabulary Routine CF training (includes online course, training book, and shipping)
$210.00 Quantity
Item subtotal:$0.00



Keys to Content WritingRegistration fee for Keys to Content Writing CF training (includes online course, training book, and shipping)
$210.00 Quantity
Item subtotal:$0.00



Keys to Early WritingRegistration fee for Keys to Early Writing CF training (includes online course, training book, and shipping)
$210.00 Quantity
Item subtotal:$0.00



Total

$0.00
Participant Information

Cohort information.
Please download this Participant Information Sheet template to use to add participant information for your cohort.

For Shipping:

If you need to ship manuals to your individual participants, please add their addresses in your Participant Information Sheet. Please note, shipping to individual addresses may incur additional costs.

For shipping all materials to one address, please add the shipping address in the section below rather than on the Participant Information sheet.
Please upload participant list here.

For edits to your list, please contact sarah.byrne@keystoliteracy.com
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Shipping and Billing Information

For questions contact sarah.byrne@keystoliteracy.com
Payment Information

Please upload your purchase order below or mail checks to: Keys to Literacy 319 Newburyport Turnpike Suite 205 Rowley, MA 01969. If you need to submit your purchase order at a later date, please email it to sarah.byrne@keystoliteracy.com as soon as possible. We are unable to ship materials or enroll participants into the online course until a payment is received.
Please upload purchase order here

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Would you like us to ship materials immediately?*

Yes! Please ship as soon as possible.No, please ship closer to training date. (typically arrives 1 week prior)
Shipping Address (all manuals must be shipped to one address)*

Street Address

Street Address Line 2

CityState

Zip Code
Billing Address (Skip if same as shipping)

Street Address

Street Address Line 2

CityState

Zip Code
Should be Empty:

Certified Facilitator Order Form

Certified Facilitator Information

Cohort information

Online Course Start Date

Materials Needed:

Participant Information

Shipping and Billing Information

Payment Information