Trauma Informed Schools - Leadership Academy - Registration
Events Details:
Date: Wednesday, June 5, 2019 and Thursday, June 6, 2019
8:00 a.m. - 3:30 p.m.
Location: Fairfield County Educational Service Center (955 Liberty Drive, Lancaster, OH 43130)
Cost: $25.00 per team member (includes breakfast and lunch for both days)

Download the informational flyers at

Please complete the registration form below. If you have any questions or concerns, please contact Will Kirby at or 740.653.3193.

District or Organization Name *
Your answer
Last Name of Person Completing Registration *
Your answer
First Name of Person Completing Registration *
Your answer
What is your email address? *
Your answer
What is your role (i.e. mental health/school counselor, teacher leader, administrator)? *
Your answer
How many team members (including yourself) will be attending June 5th and June 6th? *
List the names of each team member attending the two day leadership academy. *
Your answer
From the list below, please select the payment method for the attendees at the 2-day Trauma Informed School - Leadership Academy. The ESC does not currently accept credit card payments, so you will need to pay by personal check or purchase order. *
Breakfast and lunch will be served, please inform us of any dietary restrictions we need to be aware of. List the name of the individual and the dietary restriction.
Your answer
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