NWSE Professional Development Online Registration

Thank you for your interest in the Specially Designed Instruction: A Guided Discussion training! Please complete all of the information on this form in order to complete your registration.

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* 1. Participant Name

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* 2. School District

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* 3. Your Position

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* 4. Email address
Note: This information will be used to confirm your registration, as well as to contact you in the event of a change/cancellation associated with the event. Please use your school email address, if possible.

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* 5. Phone number (Please use a summer contact number)
Note: This information may be used to contact you in the event of a change/cancellation in the event.

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* 6. Please indicate any special needs/accommodations.

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* 7. Please provide your IEIN number, which is now required to any professional development provider through the State of Illinois before receiving your professional development units.

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* 8. Lunch Choices
Choose One

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* 9. If Salad, choose dressing

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* 10. If sandwich, choose bun type

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* 11. Sandwich meat, choose up to 3 slices

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* 12. Sandwich cheese, choose one

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* 13. Sandwich extras

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* 14. Side, choose one

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* 15. Desert, choose one

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