SEPAC Summer School 2023 Registration Form

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X-I am registering for the following 2023 SEPAC Summer School sessions:(Required)

I am registering for the following 2023 SEPAC Summer School sessions:(Required)

June 21, 2023

June 28, 2023

July 5, 2023

July 12, 2023

July 19, 20203

July 26, 2023

First Name(Required)

Last Name(Required)

Email(Required)

Home Address/Street and Number(Required)

City/Town(Required)

State(Required)

Zip Code(Required)

School District(Required)

Name of your SEPAC(Required)

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x_School District

My SEPAC role: (check all that apply)(Required)

SEPAC Chair or Co-Chair

SEPAC Vice Chair

SEPAC Secretary

SEPAC Treasurer

SEPAC Board member

Parent/SEPAC member

Other

Primary Language(Required)

To which gender do you identify as? (optional)

What is your ethnicity? (optional grant reporting question)

If applicable, what is the ethnicity of your child/youth with special needs? (optional grant reporting question)

What is your race? (optional grant reporting question)

If applicable, what is the race of your child with special needs? (optional grant reporting question)

What is the highest level of education that you have completed? (optional)

If applicable, what is your child's disability? (optional grant question, please check all that apply)

If applicable, how old is your child with special needs? (optional grant question)

Current knowledge and experience

Please share a bit about your background and experience.

Please share your reasons for attending SEPAC Summer School and how attending will support you, your family/community members, and/or others?

Please provide any additional information that will help us address your learning goals and expectations.

Please share your accessibility needs and we will do out best to reasonably accommodate you.

Your Support
Moves Dreams
Forward

From our information specialist-staffed Information Center to our annual Visions of Community Conference, your generous support helps inform, educate and empower families with the information they need to ensure better outcomes for their children.

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Current knowledge and experience

Your Support Moves Dreams Forward

Your Support
Moves Dreams
Forward