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CodeVA Special Event Registration
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Courses Exist
Primary Email [All CodeVA communications will be sent to this email first]
*
Key
Check the box if you would like your Key emailed to you.
Correct_Key
Access
Contact Information [Section 2 of 4]
Teacher_ID
Email (Alternate) *
Name *
First Name
Last Name
Phone *
Phone (Alternate)
Address *
Address Line 1
City
State
Zip Code
Date of Birth *
Gender
T Shirt Size
Food Allergies
Technology Access [Select all that apply]*
Can you install software on your device?
Internet Access [ 1 = No Internet, 5 = Fast, Reliable Internet] *
CodeVA is dedicated to following the principles of
Universal Design
when delivering online professional development. If you require any special accommodations, please let us know so that we can do our best to meet your needs.
Please check the box if you need any special accommodations.
Please let us know what accommodations you may need to fully participate in our online sessions.
School Information [Section 3 of 4]
School *
Other Division
Other School
Job Title
Current Role*
Grade Level
Endorsements*
Please list your endorsements
Years of Experience
What courses will you teach next year?
Emergency Contact Information [Section 4 of 4]
Emergency Contact Name *
First Name
Last Name
Emergency Contact Email *
Emergency Contact Telephone *
Emergency Contact Relationship *
Upcoming Events [Section 1 of 4]
Select Event(s)
Event Description(s)
Registered
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