Kindergarten Inclusion Cohort Application

If you prefer to mail in your application, please click here to download and print the Kindergarten Inclusion Cohort application (PDF) and mail it back to us as soon as possible. Or you can fill out the confidential form below for a faster response.
 

1. All fields are required.

Parent / Caregiver Information

1. Parent / Caregiver Name(required)
2. Address(required)
3. Phone(required)
4. Email(valid email required)

Child's Information

1. Child's Name(required)
2. Child's Birthdate(required)
3. Child's Age(required)
4. List 3 of your child's strengths:(required)
5. List 3 of your child's needs:(required)
6. Disability label / Diagnosis(required)
7. School District(required)
8. When will your child be entering kindergarten?(required)

By joining the Kindergarten Inclusion Cohort I agree to (check all):

1. Attend all sessions (dates TBD)
2. Complete research and homework assignments
3. Register and attend the All Born (In) Cross Disability Inclusion Conference, April 2014
4. Pay the enrollment fee of $50, plus the registration fee for the All Born (In) Conference (amount TBD)
5. Fully participate, and support all members of the cohort

Tell Us a Litte More About You

1. Why do you want to be a part of this cohort(required)
2. What would you like to learn? (required)
3. What skills would you like to share? (required)

 

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