2018 I'm Determined Youth & Parent Mini Summit Online Registration Form
Saturday, April 14, 2018
9:00 AM to 12:00 PM
Doors open at 8:30 AM

Pizza Lunch Provided

Frederick County Middle School
4661 N Frederick Pike
Winchester, VA 22603

The youth and parent mini-summit is geared toward those receiving special education services. Space is limited and registration is required. The I'm Determined Project is a state directed project funded by the Virginia Department of Education which focuses on providing direct instruction, models, and opportunities to practice skills associated with self-determined behavior. Questions should be directed to Susie Gerometta at 540-665-0103.

I'm Determined
Name *
Your answer
Age *
Your answer
Student Accommodations Required? *
If yes, accommodations needed.
Your answer
*
Grade *
Special Education Teacher
Your answer
Student will be accompanied by: *
Each student is required to be accompanied by an adult during the entire summit.
Parent/Guardian Name *
Your answer
Street Address *
Your answer
City *
Your answer
Zip *
Your answer
Email
Your answer
Contact Number *
Your answer
Parent/Guardian Accommodations Required? *
If yes, accommodations needed.
Your answer
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