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Event Submission Form

Event Title:
Event Date:
Event Time:
Location:
Event Cost:
Sponsor Name:
[ This name should appear on Attendance Verification Form. ]
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. ]
Number of Contact Hours (required):

One (1) Contact Hour = Sixty (60) minutes of direct instruction, lecture, seminar or practical teaching.

Number of Topic Areas:
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):
Presenter(s): [ List degree, title, and professional affiliation. ]
Contact Person E-Mail:
[ required ]
Contact Person Name, Mailing Address, and Daytime Phone:
[ required ]
To print or send form (mail or fax), please use the printable version of this form.

Click here for the printable version
Click submit and your information will be automatically emailed to ALTA:


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