ICI District Intake Form - Edu20/20 | Support, Coaching, & Training For Teachers & Leaders

Intake Form - District Instructional Coaching Institute

We’re excited to partner with you! To help us get started, please complete the intake form below.

District or Company *

information above the

Name of person completing this form: *

First

Last

Edu20/20 will refer to this contact as the site facilitator.

Email for above contact: *

Confirm Email

Phone number for above contact: *

Shipping address for books and materials: *

Address Line 1

Address Line 2

City

State

Zip Code

Please provide an address for us to ship training materials to. All registered coaches and leaders will receive a copy of How to Coach Teachers to Teach (Almost) Anything by Jill Jackson, along with the training handouts.

Preferred training dates: *

Please list THREE possible training dates or ranges, in order of preference (e.g., March 12, April 4, May 10). We'll do our best to confirm one that fits your team's needs.

Number of participants you are registering: *

You will enter the participants' information below.

Please read and acknowledge the following statements by checking the boxes: *

I understand that all training materials will be shipped to the address I've provided and quantities are based on the number of participants listed above.
I understand that it is my responsibility as the site facilitator to ensure delivery of training materials to the training site and to promptly communicate with Edu20/20 about any issues regarding materials.
I understand that it is my responsibility as the site facilitator to communicate the dates, times, and location of the training to all participants.

Any additional information you'd like us to know:

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Jill Jackson Leadership Retreats!

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Request a Proposal

Get notified about upcoming Jill Jackson Leadership Retreats!

Get Instant Access

Get Instant Access

Get notified about upcoming
Jill Jackson Leadership Retreats!