IEQ Reading Project Registration

Personal Information

First Name: Last Name:

Middle Initial:

Home Address: Home Phone Number:

Cell Number:

Personal email (if different from school email):

School Information

School Name: District:

School Address: School Phone Number:

Your school email address:

Please list all the subjects you currently teach:

Please list all the grade levels you currently teach:

What would you like to gain as a teacher by being a participant in this program?

How would you like your school to benefit from this program?

How do you plan to collaborate with other teachers in this program?