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.

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.

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

Please be sure to include your credentials.

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

Event Info

Continuing Education

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.
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
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

List degree, credentials, title, and professional affiliation.

If this was previously presented, please provide details (date / location) for previous presentation(s).
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