| Event Title: |
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| Event Date: |
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| Event Time: |
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| Location: |
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| Event Cost: |
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Sponsor Name:
[ This name should appear on Attendance Verification Form. ] |
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| Sponsor Affiliation: |
A: The Academic Language Association
B: ALTA Affiliated therapist training programs
C: Organization concerned with dyslexia and related learning disabilities
D: University or college
E: Individual
[ If an individual, please mailto:admin@altaread.org ]
F: Other
[ If "Other", please fill in the next field: ] |
Other Sponsor Information:
[ Only necessary if you selected "F: Other" above. ] |
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| Number of Contact Hours (required):
One (1) Contact Hour = Sixty (60) minutes of direct instruction, lecture, seminar or practical teaching.
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| Number of Topic Areas: |
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| Topics (Check All That Apply): |
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 |
| Briefly describe program, goals, and/or projected outcomes (also describe topic area(s) from "Other" above, if applicable): |
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| Presenter(s): [ List degree, title, and professional affiliation. ] |
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Contact Person E-Mail:
[ required ] |
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Contact Person Name, Mailing Address, and Daytime Phone:
[ required ] |
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| To print or send form (mail or fax), please use the printable version of this form.
Click here for the printable version
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Click submit and your information will be automatically emailed to ALTA: |
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