Dyslexia Friendly Librarian Challenge Completion Form

Complete the form below to receive your Dyslexia Friendly Librarian Certificate and a PQBD pin!

Question Title

* 1. Name

Question Title

* 2. Library System

Question Title

* 3. Position at the library

Question Title

* 4. Email Address

Question Title

* 5. Mailing Address

Question Title

* 6. I completed the following activities

DOE Module

IDA Fact Sheets* indicate which ones in the space below

Visit and explore the Decoding Dyslexia Virginia Facebook Page

Dyxlexia documentary

Simulation

I read the following IDA fact sheets:

Question Title

* 7. What impact will this challenge have on your work?

Question Title

* 8. I am interested in hosting a Decoding Dyslexia support group in my library. I understand I only act as host--the participants run the group.

Yes

Maybe, I need more information

Question Title

* 9. My library would like to know how to become a Dyslexia Friendly Library.

Yes-please respond to the comment field below.

Please list who should be contacted with more information on how to become a Dyslexia Friendly Library.

Dyslexia Friendly Librarian Challenge Completion Form

Question Title

* 1. Name

Question Title

* 2. Library System

Question Title

* 3. Position at the library

Question Title

* 4. Email Address﻿

Question Title

* 5. Mailing Address

Question Title

* 6. I completed the following activities

Question Title

* 7. What impact will this challenge have on your work?

Question Title

* 8. I am interested in hosting a Decoding Dyslexia support group in my library. I understand I only act as host--the participants run the group.

Question Title

* 9. My library would like to know how to become a Dyslexia Friendly Library.

* 4. Email Address