Registration of Referred Teacher for Ambassador Program Price: Free for access until June 30, 2023 First Name: First Name Required Last Name: Last Name Required Your school's name :* Your school's name is Required School Principle's Name : School Principle's Name is not valid School Address (Street, City, State, Zip) :* School Address (Street, City, State, Zip) is Required School Phone Number :* School Phone Number is Required Name of the Ambassador who referred you :* Name of the Ambassador who referred you is Required Your title/role :* Your title/role is Required ------ParentGeneral Education TeacherSpecial Education TeacherResource Room TeacherSpeech Language PathologistSocial WorkerSchool PsychologistGuidance CounselorOccupational TherapistAdministrator Tell us about the type of classroom or group you plan to use the curriculum with (inclusion, self-contained, small group, push-in, etc.) : Tell us about the type of classroom or group you plan to use the curriculum with (inclusion, self-contained, small group, push-in, etc.) is not valid How many students do you plan to engage with the curriculum this year? : How many students do you plan to engage with the curriculum this year? is not valid Please select what percentage of your class fall into each of the IDEA disability classifications below. : Please select what percentage of your class fall into each of the IDEA disability classifications below. is not valid Specific Learning Disability :* Specific Learning Disability is Required None 1% - 25% 25% - 50% 50% - 75% 75% - 100% Speech Language Impairment :* Speech Language Impairment is Required None 1% - 25% 25% - 50% 50% - 75% 75% - 100% Other Health Impairment (ADD, ADHD) :* Other Health Impairment (ADD, ADHD) is Required None 1% - 25% 25% - 50% 50% - 75% 75% - 100% Autism :* Autism is Required None 1% - 25% 25% - 50% 50% - 75% 75% - 100% Intellectual Disability :* Intellectual Disability is Required None 1% - 25% 25% - 50% 50% - 75% 75% - 100% Emotional Disturbance :* Emotional Disturbance is Required None 1% - 25% 25% - 50% 50% - 75% 75% - 100% Deaf-Blindness / Deafness / Hearing Impairment :* Deaf-Blindness / Deafness / Hearing Impairment is Required None 1% - 25% 25% - 50% 50% - 75% 75% - 100% Visual Impairment :* Visual Impairment is Required None 1% - 25% 25% - 50% 50% - 75% 75% - 100% Orthopedic Impairment :* Orthopedic Impairment is Required None 1% - 25% 25% - 50% 50% - 75% 75% - 100% No IEP :* No IEP is Required None 1% - 25% 25% - 50% 50% - 75% 75% - 100% Other : Other is not valid None 1% - 25% 25% - 50% 50% - 75% 75% - 100% If you selected other above, please enter the specific diagnosis here : If you selected other above, please enter the specific diagnosis here is not valid Please feel free to elaborate on the specific learning challenges and disabilities you are working to accommodate in your classroom. : Please feel free to elaborate on the specific learning challenges and disabilities you are working to accommodate in your classroom. is not valid SuperDville targets 3rd - 5th graders but is used and enjoyed by 2nd graders. Please mark the grade(s) with whom you plan to use the curriculum. :* SuperDville targets 3rd - 5th graders but is used and enjoyed by 2nd graders. Please mark the grade(s) with whom you plan to use the curriculum. is Required 2nd Grade 3rd Grade 4th Grade 5th Grade Username:* Invalid Username Email:* Invalid Email Password:* Invalid Password Password Confirmation:* Password Confirmation Doesn't Match I have read and agree to the Terms of Service* I wish to join the SuperDville mailing list to receive updates, kid friendly activities, and more! We Respect Your Privacy No val Please fix the errors above
