Facilitator Registration Form 

Facilitator Type*

School Attending

Grade

Are you a PTA/PTSA member?

What size T-shirt do you wear?

Workshop to Facilitate Session 1 (9:00AM -9:55AM)

Workshop to Facilitate Session 2 (11:10AM - 12:05PM)

Workshop to Facilitate Session 3 (2:00PM - 2:55PM)

Workshop to Facilitate Session 4 (3:55PM - 4:50PM)

We will interview students, facilitators, and volunteers, chronicle successes, and make a video of the summit. Parents of minors, do we have parental permission to videotape or photograph your student? Answers will be verified with a parent.*