Registration Form - Operation: Leave Your Mark - Legend In the Making (Flagship Program)
Operation: Leave Your Mark provides a professional learning community that utilizes practical professional development, researched based resources, and hands on training to accelerate teacher growth and student achievement.
First Name *
Your answer
Last Name *
Your answer
Job Title (Include Grade Level & Subject) *
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 teaching experience do you currently have? *
Your answer
Are you currently certified? *
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, July 21st (5:00 pm - 7:00 pm), Saturday, July 22nd (9:00 am - 3:00 pm), and Sunday, July 23rd (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
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