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* 1. What is your full name?

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* 2. What is a good email address to contact you during the summer?

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* 3. IF the summer email provided is not your work email, please also provide your work email.

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* 4. What is your current job title?

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* 5. What is your school district, BOCES, or region?

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* 6. What amount of FTE do you have allocated for coaching? Enter a number from 0 up to 1.0.

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* 7. Are you supporting a school within the Bullying Prevention Education Grant (BPEG)? 

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* 8. Briefly describe your current role and responsibilities (include all of your duties, particularly if you are less than full-time for coaching).

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* 9. Choose your comfort level with Universal PBIS content:

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* 10. How many years of experience do you have coaching schools (not limited to PBIS)?

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* 11. How many years of experience do you have coaching schools with Universal PBIS implementation?

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* 12. Have you received leadership approval to participate in this Training Series?

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* 13. Please list 1-4 potential schools that you could coach and support during the school year and who can attend the 3 days of PBIS within MTSS Training.

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* 14. Which region will your school team(s) attend school level day trainings? 

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