Dyslexia 101 Request Form

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To customize information concerning your Dyslexia 101 Workshop inquiry, please provide as much information as possible. Once this form is received, a representative of PBIDA will be in touch to further discuss your request. Thank you for your interest.

Please note: Dyslexia 101 workshops require a two month lead time to schedule.

Your First and Last Name *

Your Title *

Your Email Address *

Best Number to Contact You

Requesting Organization Name

Organization Mailing Address

Please include street, city, and zip code

Organization Contact for Invoicing

Please list full name as well as phone number or email address

Type of Workshop

Virtual

In-Person

Workshop Date(s)

Please list primary and possible alternatives

Workshop Time(s)

Please note typical workshops run 2 hours

Anticipated # of Participants

PARTICIPANTS

Check all that apply

Parents

Elementary Teachers / Staff

Elementary Paraprofessionals

Elementary Administrators

Middle School Teachers / Staff

Middle School Paraprofessionals

Middle School Administrators

High School Teachers and Staff

High School Paraprofessionals

High School Administrators

School Board

Community

University Students

Additional Notes:

Please include any other pertinent information here

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