IEP Refresher and Care Binder
Workshop
Please complete this registration form if you plan to attend the
IEP Refresher and Care Binder
Workshop
on
April 17th
from
11am - 2pm
at the
North East Library
in
North East, MD.
First Name
Last Name
Email
Phone
Please describe yourself:
Parent/Guardian
Other Relative
Student/Youth
Professional
Organization/Company
County of residence
Please select...
Washington
Allegany
Anne Arundel
Baltimore City
Baltimore County
Calvert
Caroline
Carroll
Cecil
Charles
Dorchester
Frederick
Garrett
Harford
Howard
Kent
Montgomery
Prince George's
Queen Anne's
Somerset
St. Mary's
Talbot
Wicomico
Worcester
Out of state (not in Maryland)
What is your race?
(This question helps PPMD to ensure we are reaching everyone in our community and receive grants to fund our programming.)
Please select...
American Indian or Alaska Native
Asian or Asian American
Black or African American
Native Hawaiian or other Pacific Islander
White or Caucasian
Two or more races
Other
Prefer not to answer
What is your ethnicity?
(This question helps PPMD to ensure we are reaching everyone in our community and receive grants to fund our programming.)
Please select...
Hispanic or Latino
Non-Hispanic or Latino
Prefer not to answer
What is your child's race?
(This question helps PPMD to ensure we are reaching everyone in our community and receive grants to fund our programming.)
Please answer for your child with a disability or special healthcare need if applicable.
Please select...
American Indian or Alaska Native
Asian or Asian American
Black or African American
Native Hawaiian or other Pacific Islander
White or Caucasian
Two or more races
Other
Prefer not to answer
What is your child's ethnicity?
(This question helps PPMD to ensure we are reaching everyone in our community and receive grants to fund our programming.)
Please answer for your child with a disability or special healthcare need if applicable.
Please select...
Hispanic or Latino
Non-Hispanic or Latino
Prefer not to answer
What is your child's age?
Please answer for your child with a disability or special healthcare need if applicable.
What is your child's gender?
Please answer for your child with a disability or special healthcare need if applicable.
Please list any disabilities your child has:
Contact Information