Registration Form - Destination Discovery
Destination Discovery works to empower support staff such as paraprofessionals and teaching assistants to discover their potential and passion to actively contribute to the academic success of their students.
First Name *
Your answer
Last Name *
Your answer
Job Title (Please Include Grade Level, Subject, and specific role responisiblities (i.e. Reading interventionist, Kindergarten Paraprofessional, etc.) *
Your answer
Full School Name *
Your answer
Address (Home) *
Your answer
Address (School) *
Your answer
Phone Number (Personal) *
Your answer
Phone Number (School) *
Your answer
What are your expectations for the program? How do you plan to benefit? *
Your answer
Who is your school based support person? (Coach, Master Teacher...) Please provide name and email address. *
Your answer
How many years of experience do you currently have in education? *
Your answer
Do you have plans to transition to a lead teacher role? *
Please list one strength you bring to the classroom. *
Your answer
Please list one area you would like to grow in this year as it relates to teaching. *
Your answer
Name a Legend you admire. *
Your answer
What is your favorite quote? *
Your answer
T-Shirt Size *
Media Release - By signing below, you agree that you have been notified of the possibility that your image may be included in photographs or video and authorize the use for public print, display or broadcast. I GIVE permission for my photograph to be used for Legacy-related public media and website. *
Required
Program Orientation - Friday, August 4th 5:00 pm - 7:00 pm), Saturday, August 5th (9:00 am - 3:00 pm), and Sunday, August 6th (2:00 pm - 4:00 pm) I will be able to attend all orientation sessions. *
Registration Payment: Please provide the name and email address of the Business Manager/School Leader responsible for remitting payment. An invoice will be sent to that person directly. *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Legacy Inventive Solutions for Schools. Report Abuse - Terms of Service