If you plan to register for this event, please include your name & email, your child's name, and your child's grade below. The additional questions are optional, but they offer key information that will help us to form the small groups for discussion. If you have multiple children whom you would like to attend, please fill out the sruvey for each child.  Thank you.

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* 1. What is your name? (Please provide your first and last name.)

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* 2. What is the best email for us to use to reach you?

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* 3. What is your child's name? (Please provide both the first and last name.)

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* 4. What grade is your child in?

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* 5. Where is your child on his/her dyslexia journey?

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* 6. What does your child struggle with in terms of his/her learning differences?

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* 7. What would you like your child to get out of the peer-to-peer mentoring event?

Thank you for answering this questionnaire.  Your responses will help us plan the evening. 

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