LACCS
registration form
Completion of this form is necessary for consideration in the 2020-21 LACCS cohort at Alverno College. School leadership teams are encouraged to apply as well as individuals. School teams should include a school administrator.
Application
For 2020-2021, this one-year program normally priced at $4,500/participant will be offered at the discounted rate of $1,200/participant. Some additional financial support may be provided. Requests with explanation of financial need should be submitted in writing.
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Required Field
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First Name
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Last Name
Preferred Name (for name badge)
Cell Phone
Home e-mail
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School District
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School
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Work Address
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City
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State
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Zip
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Work Phone
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School e-mail
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Total years as an educator
Current position
Total years in current role
Number of years at current school
Please answer the following questions:
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1. What do you hope to gain from your experience In the year-long program?
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2. Does your school currently have an intentional character education initiative? (If yes, please describe it briefly.)
3. How will you arrange for your responsibilities to be covered when you are out of your building to attend the sessions?
4. Do you have any special needs for participation in the program?
5. Additional comments:
Payment Option:
Invoice My School (Please include contact name, address, email, and PO # if needed)
To complete this application, please send a letter of support from your immediate supervisor stating that he or she will support your attendance at each LACCS session throughout the year to
alverno.outreach@alverno.edu.
For more information, contact Julie Borgealt at
julie.borgealt@alverno.edu
or at 414-382-6435
