Positive Discipline #2 Survey

Positive Discipline #2

1. Positive Discipline #2

Positive Discipline

A free series of workshops for parents of secondary students receiving special education services. Behavior Basics, Your Greatest Behavioral Challenge, Proactive/Preventive Strategies and much more.

March 12, 2009
10:00 a.m. - 12:00 p.m.
Burke Center Library
5935 Fred Oaks Road
Burke, VA
Dunn Loring, VA 22027

1. Name

Name

2. phone number

phone number

3. e-mail address

e-mail address

4. How did you hear about this workshop?

	Please Check answer
PRC web site	How did you hear about this workshop? PRC web site Please Check answer
PRC Newsletter	PRC Newsletter Please Check answer
Keep In Touch Email	Keep In Touch Email Please Check answer
Flyer sent home	Flyer sent home Please Check answer
Parent group	Parent group Please Check answer
Listserv	Listserv Please Check answer

Other (please specify)

5. Accommodations are available for workshops. Please let us know
two weeks in advance if you need any of these services or contact
the PRC at 703-204-3941.

	Yes	No
Do you need accommodations to attend this workshop?	Accommodations are available for workshops. Please let us know two weeks in advance if you need any of these services or contact the PRC at 703-204-3941. Do you need accommodations to attend this workshop? Yes	No

Please provide a short description of required needs?

6. Interpreters are available for workshops. Please let us know
two weeks in advance if you need any of these services or contact the PRC at 703-204-3941.

	Yes	No
Do you need an interpreter to attend this workshop?	Interpreters are available for workshops. Please let us know two weeks in advance if you need any of these services or contact the PRC at 703-204-3941. Do you need an interpreter to attend this workshop? Yes	No

Please provide a short description of required needs?

7. Additional Participants: If you are registering additional
participants,please indicate the total number in your group.

Additional Participants: If you are registering additional
participants,please indicate the total number in your group.
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