Lynchburg Area VDOE Diploma Options Workshop REGISTRATION FORM (NOTE: Each attendee must complete his/her own registration.) Question Title * 1. Attendee Contact Information LAST Name FIRST Name Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Phone Number Question Title * 2. What is your participant status (Optional) Parent/Guardian Advocate Community Stakeholder Other If you marked "Other" - please define Question Title * 3. What would like to see offered in future VDOE Workshops? Check all that apply Child Find Requirements Extended School Year (ESY) Services Evaluation Procedures Eligibility Determination Dyslexia School Anxiety Manifestation Determination Review (MDR) Procedures Prior Written Notice Resolving Disputes Section 504 Least Restrictive Environment (LRE) Other Other (please specify) SUBMIT