VDOE Parent Workshop - FBA/BIP and Section 504 Survey

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.)(Required.)

LAST Name

FIRST Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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. (Required.)

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.

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.

4.What is your participant status (Optional)(Required.)

Parent/Guardian

Advocate

Community Stakeholder

Other

If you marked "Other" - please define

5.If you participating in both sessions and desire a lunch - please indicate any dietary restrictions you must have accommodated.

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.(Required.)

Yes - I understand the above statement.

VDOE Parent Workshop - FBA/BIP and Section 504

REGISTRATION FORM (NOTE: Each attendee must complete his/her own registration.)