BRAINSPRING PreRegistration Form (Level II)

Personal Information

Full Name*

First Last

Email Address*

Educator ID / License Number*

If you do not know this number, you can look it up using the License Look-up Tool at https://sso.mde.k12.ms.us/Login/Login.aspx.

School District*

School*

School Address*

Street Address City State / Province / Region ZIP / Postal Code

Current Position*

Grade(s) Served*

Check all that apply.

# of Students with IEPs*

Please enter a number from 1 to 50.

# of Students without IEPs*

Please enter a number from 1 to 50.

Principals's Name*

First Last

Principals's Email*

Curriculum Director’s Name*

First Last

Curriculum Director’s Email*

SPED Director's Name*

First Last

SPED Director's Email*

Which Level I course did you attend?*

Did you complete online or in person, if in person what city?*

When did you attend the Level I Phonics First® course? Please enter the DAY ONE date.*

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DD

YYYY