Name *

First Name

Last Name

Phone *

(###)

###

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Location *

Please enter the address for where you would like the workshop to be held.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Event

Requested date of event

MM

DD

YYYY

Workshop of Interest *

Please select the workshop(s) you are interested in hosting.

Classroom Management

Differentiated Learning

Reading of Purpose

Effective Writing Strategies

Culturally Responsive Teaching Practices

Other/Customized PL Experience