Group Event Submission Form

Group 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.

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

For CEU events, please be sure and submit this request at least 2 weeks prior to the event. CEU hours will only be approved in advance. Please do not request approval for past events.

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

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Contact Info

Name:
Please be sure to include your credentials.
Email:
Daytime Phone:
Please enter in ###-###-#### format.

Event Info

Include in ALTA Calendar? Yes
No
Event Type: Continuing Education
Non-CEU
ALTA Chapter:
Event Title:
Start Date:
Please enter in mm/dd/yyyy format.
Start Time:
Please enter in hh:mm am/pm or 24 hour format.
End Date:
Please enter in mm/dd/yyyy format.
End Time:
Please enter in hh:mm am/pm or 24 hour format.
Location Name:
Location Address:
Location City:
Location State:
Location Zip:
Event Cost:
Sponsor Name:
This name should appear on Attendance Verification Form.
Sponsor Affiliation: ALTA Chapter - Arkansas
ALTA Chapter - Mississippi
ALTA Chapter - New York
ALTA Chapter - Ohio
ALTA Chapter - Rocky Mountain
ALTA Chapter - Texas
ALTA Chapter - Texas - North Texas
ALTA Chapter - Texas - South Texas
ALTA Chapter - Texas - West Texas
ALTA Chapter - Texas - East Texas
IMSLEC Accredited Training Program
International Dyslexia Association
Organization concerned with dyslexia and related learning disabilities
University or College
Individual
Other
If "Other", please fill in the next field.
Other Sponsor Information:
Only necessary if you selected "F: Other" above.
Registration / More Info Link:
If desired, please include a link where interested parties may learn more about or register for this event.
Number of Contact Hours (required):
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.
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
Please provide a description of the event and how it specifically relates to dyslexia or how it supports the use of current research based methods. Also describe topic area(s) from "Other" above, if applicable. This is the description that will show up on the ALTA Calendar if you have opted to publicize your event.
 
Presenter(s):
List degree, credentials, title, and professional affiliation.
Was this previously presented?
If this was previously presented, please provide details (date / location) for previous presentation(s).
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