BrainSTEPS Team Application 2025-26
You will receive an email with additional information and registration details once your application is approved. New Team Member 1-DAY Training is required for all incoming members and will be held virtually.

The same training will be available on two different dates to provide flexibility for participants:
  • Tuesday September 23, 2025 from 8:00am to 4:00pm
  • Thursday October 2, 2025 from 8:00am to 4:00pm
This application must be received by SEPTEMBER 8TH, 2025, to attend the training. LATE APPLICATIONS WILL NOT BE ACCEPTED. Substitute reimbursement will be available. 

Reach out  to Jody Dickerson with any questions. Thank you for your interest in serving students with Brain Injury! 

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Date:  *
MM
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DD
/
YYYY
School District/BOCES: *
BrainSTEPS Team Leader(s)   *
Name: *
Profession:  *
Job Title:  *
Email address (work):  *
Phone number:  *
Address (work):  *
Please list current job responsibilities:  *
PREVIOUS TRAINING AND/OR EXPERIENCE IS NOT REQUIRED
Please list any experience you have working with students with Brain Injury:  *
Please summarize any previous Brain Injury Training experience:  *
Please write a brief statement describing your interest in serving on a BrainSTEPS CO  Team and what you believe your contributions to the team and students might look like.   *
Supervisor Information
There is an expectation that you have discussed BrainSTEPS CO with your district and/or building level supervisors, and have been approved to participate in required trainings and team member responsibilities. 
Verify you have discussed this with your supervisor.  *
Required
Supervisor Information
Please provide the following information for your supervisor.
Supervisor Name:  *
Supervisor Title: *
Supervisor Email *
Supervisor Phone Number *
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