Workshop Request Planning Form

Please indicate your preferred workshop date & time. Please note: We do not guarantee workshop dates or times until a workshop agreement is completed.

Please indicate a backup workshop date & time. Please note: We do not guarantee workshop dates or times until a workshop agreement is completed.

Please provide your first and last name.

Please describe your role within your organization.

Please provide the name of the school, district, agency, or organization for which you are requesting a workshop.

Please provide an email address to allow us to contact you.

Please provide a complete phone number (999) 999-9999 to allow us to contact you.

Please select the title of the workshop you are requesting.

If you selected Other Workshop Interest Not Listed above, please provide a description of the workshop you would like the Center for Dyslexia to provide.

How many members of your organization will attend this workshop?

Please indicate what role within your organization the attendees hold. You may select as many roles as are applicable for attendees to this workshop session by holding the Control Key (or Command Key on a Mac) as you select the roles.

Please share what motivated your request for this workshop.

What specific knowledge do you want educators to have gained from this workshop?

What specific skills do you want educators to have gained from this workshop?

What is the name of the reading curriculum, program, or approach used in your core (Tier 1) instruction? Please indicate all programs and the grade level at which they are utilized.

Does your core reading program explicitly teach decoding and spelling skills?

What is the name of the reading intervention curriculum, program, or approach you utilize within your school district for phonological and phonemic awareness? Please indicate all programs and the grade level/setting in which they are utilized.

What is the name of the reading intervention curriculum, program, or approach you utilize within your school district for decoding and spelling? Please indicate all programs and the grade level/setting in which they are utilized.

What is the name of the reading intervention curriculum, program, or approach you utilize within your school district for reading fluency? Please indicate all programs and the grade level/setting in which they are utilized.

What is the name of the reading intervention curriculum, program, or approach you utilize within your school district for reading comprehension? Please indicate all programs and the grade level/setting in which they are utilized.

What is the name of your universal screener for elementary school? Please provide information by grade level.

What is the name of your universal screener for middle school? Please provide information by grade level.

What is the name of your universal screener for high school? Please provide information by grade level.

What is the name of your progress monitoring tool for elementary school? Please provide information by grade level.

What is the name of your progress monitoring tool for middle school? Please provide information by grade level.

What is the name of your progress monitoring tool for high school? Please provide information by grade level.