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The goal of the Leadership Academy pre-conference is to help you see your own leadership potential and how you can make a difference for families with disabilities in your community.  We are asking you to commit to attending the pre-conference session to explore leadership and how you can be a part of making a difference.  We are looking for you to help lead our community by sharing information, answering questions, and learning more about the disability community.


The Leadership Academy is limited to 30 Parents / Guardians & 10 Youth participants.


The Leadership Academy is taking place at
Embassy Suites Hotel,
1000 Woodward Pl NE,
Albuquerque, NM, 87102
on April 12th, 2023 from 1:00 pm-5:00 pm.

Dinner will be provided following the Academy at the Hotel. 

Thanks to our sponsors we are able to offer this session at no additional cost. 

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* 1. I am a/Soy un: 

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* 2. First Name/Nombre:

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* 3. Last Name/Apellido:

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* 4. Telephone/Teléfono:

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* 5. Cell/Celular:

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* 6. Have you participated in Family Leadership Academy in the past?/Ha participado en la Academia Familiar del Liderazgo en el pasado?

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* 7. Address/Dirección:

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* 8. City/Ciudad:

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* 9. State/Estado:

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* 10. Zip/Código Postal:

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* 11. E-mail/Correo Electrónico:

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* 12. Ethnicity/Origen Étnico:

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* 13. Language Preference/Idioma Preferido:

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* 14. Have any of your children received Early Intervention (EI) Services?/Alguno de sus hijos ha recibido Servicios de Intervención Temprana (EI, por sus siglas en inglés)?

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* 15. If “yes”, What agency?/Si respondió "sí", ¿Qué agencia?

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* 16. Does your child have a disability; special needs or is at risk?/ ¿Tiene su hijo una discapacidad, necesidades especiales o está en riesgo de tener una? 

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* 17. If “yes” please specify and provide additional information about your child’s condition/ Si respondió "sí", especifique y proporcione información adicional sobre la condición de su hijo:

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* 18. Tell us about any challenges you have experienced in navigating early intervention, special education or health care/Cuéntenos sobre cualquier desafío que haya experimentado al navegar el sistema de la intervención temprana, educación especial o servicios médicos:

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* 19. What are you interested in learning at Family Leadership Academy?/Qué le interesa aprender en la Academia de Liderazgo Familiar?

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* 20. I understand submitting my application does not guarantee award of scholarship. If selected, I agree to attend the conference in its entirety./ Entiendo que enviar mi solicitud no garantiza la concesión de la beca. Si soy seleccionado, acepto asistir a la conferencia en su totalidad.

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