* 1. Please provide your name, address, email address, and telephone number.

* 2. Child/Children's name(s)
Age
Grade

* 3. I am participating as a:

* 4. What type of non-traditional school does your child currently attend?

* 5. School name and location

* 6. IDEA lists 13 categories of disability. Which category best describes your child's disability?

* 7. One of the goals of this project is to provide training to parents and professionals to allow them to be active leaders in their community. How do you plan to use your skills after the completion of the project?

* 8. The majority of our training's for this program will be offered on-line. Are you comfortable with your ability to access the internet regularly, view webinars, share documents and take part in Facebook conversations?

* 9. Please tell us how you hear about this program.

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