PBIS Registration Form

Positive Behavioral Interventions and Supports Registration Form

This is a group registration form for 2024-25 PBIS training with Dr. Flint Simonsen. Teams of up to no more than 5 members may register for $1,600 per team.

Teams consist of a building principal or assistant principal (required), then may have a combination of:

other administrators
counselors
gen ed teachers
special ed teachers
paraeducators
bus drivers
coaches
building support
related services staff

Please note: A team is considered a group of individuals registering together from the same school. Individuals and/or groups registering from the same district, but not the same school, are not considered part of the same team.

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Please list the information for your team below.

School Name

School District

Principal/Assistant Principal email address *This question is required. This question requires a valid email address.

Principal / Assistant Principal *This question is required.

Space Cell	Name	Email Address	Contact Phone
Principal/Assistant Principal (Required)	Principal/Assistant Principal (Required): Name	Principal/Assistant Principal (Required): Email Address	Principal/Assistant Principal (Required): Contact Phone

Team Members 2-5 (must answer at least 1 name)

Space Cell	Name	Email Address	Position
Member 2	Member 2: Name	Member 2: Email Address	Member 2: Position
Member 3	Member 3: Name	Member 3: Email Address	Member 3: Position
Member 4	Member 4: Name	Member 4: Email Address	Member 4: Position
Member 5	Member 5: Name	Member 5: Email Address	Member 5: Position