LF Registration – Scottish Rite Learning Center of South Texas

Please enter the following information and Submit to start the registration process for Language Foundations

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone

Work Phone

Academic Background

Current Role

Grade Level

Campus

School District

Highest Degree Level

Institution

Years Attended

Administration

Association

Phone Number

Is your administration aware of your application?

Educational Background (List most recent first)

following application? Is

Degree 1

Institution

Years Attended

Degree 2

Institution 2

Years Attended 2

Degree 3

Institution 3

Years Attended 3

Teaching Experience (List more recent experience first)

Professional Certifications/Affiliations

Professional References

Name/Association 1

Address 1

Phone 1

Name/Association 2

Address 2

Phone 2

Name/Association 3

Address 3

Phone 3

Please briefly answer the following questions:

Why are you interested in applying for this training?

To date, what experience have you had with dyslexia (education, professional or personal)?

How do you intend to utilize the skills of an Academic Language Practitioner in your district?