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PC READS Advocate Program Application - 2018
Applications will be reviewed on a rolling basis through September 21, 2018. This program is supported by a grant from the Park City Community Foundation.
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Email address
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Name:
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Date:
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Phone Number:
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Email:
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Address:
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City:
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State:
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Zip Code:
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I am a: (check all that apply)
Parent of a child/children with dyslexia
Parent of a child/children with other learning disabilities
Private Tutor
K-12 Special Education Teacher
K-12 General Ed Teacher
K-12 Administrator
Attorney or Advocate
Job Title (if currently employed):
Please list your educational background (name of institution, degrees earned and area of study):
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Are you fluent in any languages other than English? Please list below.
Please select all events below that you have attended:
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Gin & Phonics, June 2018
Dyslexia for a Day, April 2018
PC READS Dyslexia Awareness Presentation at Parley's Park Elementary School, March 2018
PC READS Dyslexia Awareness Presentation at Park City Sunrise Rotary, January 2018
Barbara Wilson's Presentation, October 2017
Wasatch Reading Summit, October 2017
PC READS Dyslexia Awareness Presentation to MOPS, April 2017
PC READS Dyslexia Awareness Presentation at Trailside Elementary School, March 2017
Learning Ally's Spotlight on Dyslexia Conference, December 2016
PC READS Dyslexia Awareness Presentation at McPolin Elementary School, November 2016
Wasatch Reading Summit, October 2016
Dyslexia for a Day, April 2016
Dislecksia: The Movie, October 2015
None of the above
Required
List any training, professional development or experience with dyslexia (or struggling readers) that is not covered in the above question:
Describe any experience you have working with children or adults with learning disabilities: (250-500 words)
Why are you interested in becoming a Certified Dyslexia Advocate for PC READS? (250 - 500 words)
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I agree to the following:
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I have read and understand the PC READS Advocate Program Description, including training and work expectations
I have read and understand the requirements of The Dyslexia Training Institute's Dyslexia Advocate Certificate Program
If selected, I will immediately submit my application for the Dyslexia Advocate Certificate Program
If selected, I understand this is a 2 year commitment (Fall 2018 - Spring 2020)
I understand that if I do not fulfill my commitment, I will be responsible for reimbursing PC READS for training costs
Required
If selected to become a PC READS Advocate:
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I have already completed the prerequisite course, What is Dyslexia? An In-depth Look
I plan to take the prerequisite course, What is Dyslexia? An In-depth Look (This course begins on September 10, 2018)
I plan to "test out" of the prerequisite course after reading the required text, "Overcoming Dyslexia: A New and Complete Science-Based Program for Reading Problems at Any Level, Sally Shaywitz, M.D.
If selected to become a PC READS Advocate, I am able to attend the Wasatch Reading Conference on October 2nd & 3rd, 2018 (PC READS will cover the conference fee):
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Yes
No
Maybe
A copy of your responses will be emailed to the address you provided.
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