AIMing for Achievement 10-31-12 Archived Webinar Registration

To access the archived recording of this Webinar, please submit the following information. When finished click on the box labeled DONE and the link to the archived webinar will be displayed on your screen.

Question Title

* 1. Are you a: (Please check all that apply)

Parent

Surrogate/Foster Parent

Other relative/guardian

Regular educator

Special educator

Parent Center (PTI/CPRC) staff

Professional

Student

Administrator

Other (please specify)

Question Title

* 2. If you are a parent of a child with a disability, what is your child/young adults age?

Question Title

* 3. If you are a parent of a child with a disability, what is your child/young adult’s disability?

ADD-ADHD

Autism

Deaf-Blindness

Deaf-Hearing Impairment

Developmental Delay (early Childhood)

Emotional Disturbance

Mental Illness

Intellectual Disability

Multiple Disabilities

Orthopedic Impairment-physical

Other Health Impairment

Specific Learning Disability

Speech/Language Impairment

Traumatic Brain Injury

Visual Impairment including Blindness

Other (please specify)

Question Title

* 4. If you would like to be added to PACER's mailing list, please complete the following information:

Name:

Organization (if professional):

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number: