Special Services Professional Development Academy Membership Form (2024-25) | School of Education

Special Services Academy (SSA) registrations now include attendance for 3 participants for 3 in-person sessions. The cost to register is currently $300. Attendance is taken at each session. Certificates are provided when the participant attends in person. Only registered attendees will receive certificates.

A few weeks before each session, we will send a form to the primary contact person (completer) to collect the names of the personnel from your district who will attend that specific session. Each of those individuals will then receive an email with information about location, parking, and other details pertinent to the session.

Please note: Starting this year, the Special Services Academy and the BCBA Roundtable will be two separate events held on different dates in order to accommodate requests by many of our attendees. Please visit BCBA Roundtable for more information.

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Membership Season

Completer Information

Please note: This will be your primary contact person for future communications.

Name(Required)

Please provide the full Name and Email Address of the person who is completing this registration form.

First Last

Email(Required)

School Information

County(Required)

School District(Required)

Address(Required)

Street Address City ZIP Code

Director of Special Services Name(Required)

First Last

Email(Required)

Administrative Assistant Information

Administrative Assistant Name(Required)

First Last

Phone(Required)

Email(Required)

Billing/Invoice Contact Information

Name(Required)

First Last

Position Title(Required)

Email(Required)

Phone(Required)

Payment Information

Special Services Academy 2024-2025(Required)

Price:

Total Amount Due

Is Your Purchase Order Number Available?(Required)

Yes

Name

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