Leading for Equitable Classrooms 2019 Registration

Please fill out the registration form below. Include all participants who plan to attend (including if the superintendent will attend) so we may plan and invoice you correctly.

Cost:

$350 per adult participant

$60 per student participant

(student to adult ratio of 1:1)

Superintendents of registered teams attend for free with a team of 3 or more.

If you have questions about registration please contact The Connecticut Center for School Change at 860-586-2340 or ccsc@ctschoolchange.org

Question Title

* 1. District Information

District/Organization Name

Billing Address

City/Town

State/Province

ZIP/Postal Code

Team Contact Name

Team Contact Email

Phone Number

Question Title

* 2. Participant #1 Information

Name

District Title/Role

School or Office Name

Email Address

Question Title

* 3. Participant #2 Information

Name

District Title/Role

School or Office Name

Email Address

Question Title

* 4. Participant #3 Information

Name

District Title/Role

School or Office Name

Email Address

Question Title

* 5. Participant #4 Information

Name

District Title/Role

School or Office Name

Email Address

Question Title

* 6. Participant #5 Information

Name

District Title/Role

School or Office Name

Email Address

Question Title

* 7. Participant #6 Information

Name

District Title/Role

School or Office Name

Email Address

Question Title

* 8. Participant #7 Information

Name

District Title/Role

School or Office Name

Email Address

Question Title

* 9. Participant #8 Information

Name

District Title/Role

School or Office Name

Email Address

Question Title

* 10. Participant #9 Information

Name

District Title/Role

School or Office Name

Email Address

Question Title

* 11. Participant #10 Information

Name

District Title/Role

School or Office Name

Email Address

Question Title

* 12. How did you hear about this institute?

CCSC Email

CCSC Website

Twitter

Google/web search

Word of mouth

Other (please specify)