The PEAL Center "Winter Bites" Series

Tuesdays in December & January from 12 PM - 1 PM

December 17th: Is My Child Making Progress? Let’s Look at the Data
January 7th: Skills for Educational Advocacy
January 14th Making Inclusion a Reality
January 21st: Behavior and Discipline

First Name

Last Name

County

In what role are you attending this training?

Family MemberProfessionalFamily Member and ProfessionalYouth/Young Adult

PEAL's programs are provided free for families and youth, but we do need as much of this information as you are willing to provide for our funders. The answers you provide are confidential and will not be shared.

What race do you identify as?

Do you identify as Hispanic or Latinx?

YesNoI prefer not to say

What year were you born?

What your disability category?

What race do you identify as?

Do you identify as Hispanic or Latinx?

YesNoI prefer not to say

What race does your young adult identify as?

Does your young adult identify as Hispanic or Latinx?

YesNoI prefer not to say

What year was the child/youth you are attending for born?

If you are attending for multiple children, please list all years (differentiate with commas)

What is the disability category of your young adult?

What race do you identify as?

Do you identify as Hispanic or Latinx?

YesNoI prefer not to say

Do you need accommodations to participate? If so, please specify and we will do our best to meet those needs.

Would you like to be added to PEAL's mailing list?

YesNoI am already subscribed

Contact Information