PaTTAN Strategies for Instructional Access in General Education Classrooms -- Team Application

Please complete this survey to enroll your LEA team by February 1, 2017

Before completing this application, please review the requirements for participation.
1. Identify a team to attend February 27th training.
2. Complete an Action Plan and meet regularly to discussion implementation.
3. Complete survey following implementation and participate in debriefing Webinar on May 10, 2017.
4. Submit request(s) for reimbursement for substitute costs and travel per instructions.

Question Title

* 1. Team Contact

Name

School District

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Role of Team Contact

Principal/Assistant Principal

Special Education Leader

Other Administrator (Please specify)

Question Title

* 3. Required Team Members - List name

Principal/Assistant Principal

General Educator

Special Educator

Question Title

* 4. Additional Team members - List names and roles

Team member name and role

Question Title

* 5. Name of School Building

Question Title

* 6. February 27, 2017 is a face-to-face training. At which site will your team participate?

Western Region (PaTTAN Pittsburgh office)

Central Region (PaTTAN Harrisburg office)

Eastern Region (PaTTAN East office)

Thank you for your interest in this Professional Development. PaTTAN will contact teams with acceptance and registration information. After acceptance, each team member will need to register on Coursewhere to receive Act 48 credits. Contact for questions: Jennifer Geibel, jgeibel@pattan.net 412-826-6843