LIA Educator Institute (Utah) Registration Form

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This is for the 2018-2019 school year.

Would you be interested in having a mentor LIA teacher who would help you throughout the year?

Please check below any areas that you might like specific help with

If you have taught LIA for one year or more.

Are you interested in being a Mentor teacher for a new LIA teacher in the 2018-2019 school year?

Please identify any areas of expertise / strength you have.

Health Needs and Concerns

Please list any food allergies you have.

Do you have any special dietary needs? If so, please explain.

Emergency Contact Information

Please provide information for a person we can contact in case of an emergency.