VDOE Parent Workshop - FBA/BIP and Section 504 REGISTRATION FORM (NOTE: Each attendee must complete his/her own registration.) Question Title * 1. Attendee Contact Information - (You must provide either a phone contact number or an email address so that your reservation can be confirmed with you or to notify you of any changes/cancellations related to your chosen training date.) 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. Which workshop do wish to attend? (Select only one.) NOTE: You do not have to attend both sessions in order to register for and participate in a given training date. Tidewater Area - August 13, 2018 - Location: Holiday Inn and Suites North Beach, 3900 Atlantic Avenue, Virginia Beach, Virginia 23451. NOTE: The FBA/BIP session will begin at 10:00 am and end at 11:30. The Section 504 session will begin at 12:30 pm and end at 2:00 pm. Richmond Area - August 16, 2018 - Location: Hilton Garden Inn Richmond Airport, 441 International Center Drive, Sandston, Virginia 23150. NOTE: The FBA/BIP session will begin at 10:00 am and end at 11:30. The Section 504 session will begin at 12:30 pm and end at 2:00 pm. Roanoke Area - September 5, 2918 - Location: Holiday Inn Tanglewood, 4468 Starkey Road, Roanoke, Virginia 24018. NOTE: The FBA/BIP session will begin at 10:00 am and end at 11:30. The Section 504 session will begin at 12:30 pm and end at 2:00 pm. Charlottesville Area - September 6, 2018 - Double Tree by Hilton, 9900 Hilton Heights Road, Charlottesville, Virginia 22901. NOTE: The FBA/BIP session will begin at 10:00 am and end at 11:30. The Section 504 session will begin at 12:30 pm and end at 2:00 pm. Question Title * 3. Lunch will be provided for individuals who register for and participate in both sessions. Please indicate which sessions you will be attending. I plan to participate in both the FBA/BIP and Section 504 sessions. I plan to participate only in the FBA/BIP session. I plan to participate only in the Section 504 session. Question Title * 4. What is your participant status (Optional) Parent/Guardian Advocate Community Stakeholder Other If you marked "Other" - please define Question Title * 5. If you participating in both sessions and desire a lunch - please indicate any dietary restrictions you must have accommodated. Question Title * 6. Please indicate below that you understand that, other than being provided with lunch on their selected training date, participants will not receive any reimbursements for travel, per diem, or hotel accommodations. Failure to acknowledge this statement will result in your registration being invalid. Yes - I understand the above statement. Question Title * 7. 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) Independent Education Evaluations (IEE) Homework Strategies for Students with Disabilities Other Other (please specify) SUBMIT