Passport to Literacy Registration

Please answer all the information below so we can register you for the Passport to Literacy event.

The event will be held September 16 at 9:00am at the Wilson Learning Academy in Tulsa.

Thank you!

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. How many adults will attend with you?

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* 4. How many children will attend with you?

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* 5. Please mark the age group of each child attending. ****We must know this information to plan for child care.

Infant up to 2 years old

2 years up to 4 years old

4 years up to 6 years old

6 years up to 8 years old

8 years and older

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* 6. Do you have one or more children with an IEP or an IFSP (SoonerStart)?

IEP (Individualized Education Plan)

IFSP (Individualized Family Service Plan, with SoonerStart)

Neither

Not sure

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* 7. How did you hear about this event?

Community poster/flyer (such as at the library)

Organizational contact

Facebook or email

Friend/family member

My child's teacher. Please share his or her name:

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* 8. What is your preferred phone number?

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* 9. What is an alternative phone number?

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* 10. What is your email address?

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* 11. What is your mailing address?

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* 12. Please mark your gender.

Male

Female

Prefer not to answer

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* 13. Please mark your ethnicity.

Caucasian/White

Hispanic or Latino

African-American/Black

American Indian/Native American/Alaskan Native

Asian

Native Hawaiian/Pacific Islander

Two or more races

Prefer not to disclose my ethnicity

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* 14. Is English your primary language?

Yes

No. Which language is your strongest?

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* 15. Do you need help with transportation to the event? If you mark yes, we will contact you about providing one or more bus passes for Tulsa Transit.

Yes

Not sure

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* 16. Please list any special accommodations below:

Translators/interpreters, sign interpreters, special meal requirements, and/or other special accommodations will be available upon advance request (please allow a two week notice). Any requests made after September 5, 2017, may not be available.

For more information, call 1-877-553-4332 or email lcoats@oklahomaparentscenter.org.