KTTI Registration Form

Choose the level of training you wish to take:

Classroom Educator

Associate

Certified I

Certified II

Dates and location of the training you wish to take:

First Name:

Last Name:

Address:

Cell Phone:

Email:

Highest Degree Earned

Bachelor's

Master's

Doctorate

Please list your field of studies , and Colleges/Universities attended:

Current Teaching/Work Assignment:

Previous Teaching Experience:

Previous Orton-Gillingham or related experience:

Reasons for taking taking the training:

In the event that I need to withdraw from the training whiting three weeks of beginning of the course, I am aware that the course registration fee may be nonrefundable. I understand that hte Associate / Certified practicum begins after the coursework is completed and that the practicum is an additional fee $2,500 payable over 10 installments of $250 per observation and $1250 payable over 5 observation installments for Classroom Educator. In some cases, additional observations and accompanying fees are required to meet certification requirements.

Signature:

Date:

Please submit this digital form and send a deposit fee (1/2 tuition) made payable to Kildonan Teacher Training Institute. Please send to: Kildonan Teacher Training. 473 Skiff Mountain Road, Kent, CT 06757.