Event Submission Form

Event Submission Form

If you are attempting to register for the Alliance National Registration Exam, please use the links on this page or contact us for assistance. Exam registration will not be accepted under any circumstance using this form.

If you would like to host an Alliance National Registration Exam, please contact us for more information and the form that you will need to fill out in order to administer the exam.

If your submission is for an event that is Ongoing (such as monthly events, online training, etc.), please leave the Start Date / Time and End Date / Time blank.

Please fill out this form completely, and then click the Submit button when finished.

Need to submit an Individual Event Approval Form for CEU approval? Click here for the Application for Individual Event Approval.


Contact Info



Please be sure to include your credentials.



Please enter in ###-###-#### format.

Event Info


Yes
No

Please select "Yes" only if this is a recurring or ongoing event, such as an online course. Click "Yes" ONLY if your event does not have an end date.
Yes
No

Continuing Education
Non-CEU




Please enter in mm/dd/yyyy format.


Please enter in hh:mm am/pm or 24 hour format.


Please enter in mm/dd/yyyy format.


Please enter in hh:mm am/pm or 24 hour format.








This name should appear on Attendance Verification Form.

Academic Language Therapy Association
ALTA Affiliated therapist training programs
International Dyslexia Association
Organization concerned with dyslexia and related learning disabilities
University or College
Individual
Other
If "Other", please fill in the next field.


Only necessary if you selected "F: Other" above.


If desired, please include a link where interested parties may learn more about or register for this event.


One (1) Contact Hour = Sixty (60) minutes of direct instruction, lecture, seminar, or practical teaching.
Failure to enter a number will result in an error.


Language and / or learning disorders
Applied multisensory practice and methodology
Curricula in academic language therapy
Research-medicine, psychology, education, linguistics
Professional practice, related laws and / or ethics of practice
Other



List degree, title, and professional affiliation.
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