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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.
Email address *
Name: *
Date: *
Phone Number: *
Email: *
Address: *
City: *
State: *
Zip Code: *
I am a: (check all that apply)
Job Title (if currently employed):
Please list your educational background (name of institution, degrees earned and area of study): *
Are you fluent in any languages other than English? Please list below.
Please select all events below that you have attended: *
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) *
I agree to the following: *
If selected to become a PC READS Advocate: *
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): *
A copy of your responses will be emailed to the address you provided.
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