Florida Funded Institutional Membership Application
School Name *
Your answer
School or Campus Number
Contact campus administration to obtain campus number
Your answer
District Name *
Your answer
District Number
Contact campus administration to obtain district number
Your answer
School or District Address *
Please fill out the street address of your site, not personal address. P.O. boxes are not accepted
Your answer
Primary Contact Name (required) *
This is who will be in charge of the Learning Ally grant and access at school, including adding other educators for access, and providing information to staff on training.
Your answer
Primary Contact Title *
Choose one:
Primary Contact Email *
Your school email address
Your answer
Primary Contact Phone *
Your school phone and extension
Your answer
Select roles for online access to Learning Ally for the primary contact's educator account. *
You may choose more than one, please read descriptions at the bottom of this form.
Required
Secondary Contact Name *
This is who will implement and utilize the program at school.
Your answer
Secondary Contact Title *
Please choose one:
Secondary Contact Phone *
School phone and extension
Your answer
Secondary Contact Email *
Contact's school email address
Your answer
Select roles for online access to Learning Ally for the secondary contact's educator account. *
You may choose more than one, please read descriptions at the bottom of this form.
Required
Do you plan to begin using Learning Ally with your students right away? *
How many students at your school do you anticipate using Learning Ally? *
Your answer
Roles in Learning Ally's Educator Portal
Instructor: Can add students, assign books and run progress reports.

Certifier: It is your responsibility to identify competent staff in your school who can determine students who are eligible for the Learning Ally Solution. The Competent Authority will be classified as a certifier in the educator portal and will select one of the four categories of student eligibility (Reading Accommodation, Specific Learning Disability, Blind or Visually Impaired, Other Physical Disability). *At least one certifier must be selected.

Administrator: Given the "Manage Educators" tab online and can add other teachers into school's account.

Questions?
Visit the Florida landing page: LearningAlly.org/Florida

Contact Kimberlie Hiler at kHiler@LearningAlly.org.

Thank you for completing this application.
We look forward to serving you soon.
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