Registration Form
We are excited that you'll be joining us! Please complete this registration form to notify us of your plans to participate. We cannot wait to co-create community excellence with you!
Name
*
First
Last
Identifying Pronouns
*
Please Select
They/Them
She/Her
He/His
Other
(she/her, he/him, they/them, etc.)
If Other, Please List Pronouns Here
Email
*
example@example.com
Mobile Number
*
Alternate Phone Number
Mailing Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Which language do you prefer to participate in our Institute?
*
English
Somali
Spanish
Vietnamese
Other
If you answered "Other", what is your preferred language?
Which school district do you work with?
*
Highline
Kent
North Thurston
Renton
Tukwila
N/A - Other SPEB Partner
If you answered "N/A - Other SPEB Partner" please list which entity you represent:
What school community are you a part of? (ex: "Bryn Mawr Elementary" or "N/A")
*
What sessions will you be attending?
*
I Plan on Attending
I Cannot Attend a
Session at this Time
Whole Group Plenary
(9:00-10:30a)
Morning Workshop by Focus Area
(10:30a - 12:00p)
Afternoon Workshop by School/District
(1:15-3:45p)
Whole Group Harvest & Closing
(3:45-4:30p)
What morning workshop are you most interested in attending?
*
Cultural Responsiveness
Systems Thinking
Engagement, Research, & Evaluation
Everyday Advocacy
My Commitment - Cohort Member
*
I am NOT a Cohort Member
Cohort Member - Fall Only (Nov 21, 2020)
Cohort Member - Winter Only (Jan 16, 2021)
Cohort Member - Spring Only (Mar 27, 2021)
Cohort Member - Summer Only (Jun 5, 2021)
My Commitment - Community Partner
*
I am NOT a Community Partner
Community Partner - Fall Only (Nov 21, 2020) - $125.00
Community Partner - Winter Only (Jan 16, 2021) - $125.00
Community Partner - Spring Only (Mar 27, 2021) - $125.00
Community Partner - Summer Only (Jun 5, 2021) - $125.00
Community Partner - Full Series - SAVE $200!!! - $399.00
My Agreement:
*
I understand that, as a Cohort Member, I am making a commitment to attend ALL THREE Community Learning Conferences + Graduation, and will contact SPEB to communicate any absences, ahead of time, as soon as I am aware.
I understand that, as a Community Partner, I will be emailed an invoice for the registration costs, and I will contact SPEB to make payment arrangements prior to attending the Community Learning Conferences.
Signature
*
Clear
Questions?
Please contact amber@speboard.org for more information on the Institute Series!
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