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Visual Phonics Seminar Questionnaire
Seminar Information:
*
Indicates required field
Training Start Date and Time:
*
Workshop Type
*
In-Person
Online
Host Site (name of ESC or School District):
*
Personal Information:
Name
*
First
Last
Email
*
Phone Number
*
Address
(not required, but please indicate City & State)
*
Line 1
Line 2
City
State
Zip Code
Country
Questionnaire:
1. How did you first hear about Visual Phonics?
*
people at work
friend
service club*
TV or radio*
publication*
website*
ESC staff development catalog
district/program-required staff development
other
If other, explain here:
*
*Name of service club, TV/radio program, publication, or website
*
2. Please state briefly you reasons for attending this seminar
*
3. I am a/an... (check all that apply to you)
*
preschool teacher
kindergarten teacher
first grade teacher
second grade teacher
third grade teacher
upper elementary teacher (grades 4-5)
middle school teacher (grades 6-8)
high school teacher (grades 9-12)
special education teacher
deaf educator
speech language pathologist, therapist, or assistant
reading/literacy teacher or tutor
ESL/bilingual educator
school or program administrator
parent
other
If other, explain here:
*
Do you have additional comments?
*
Submit
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