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LARGE DISTRICT REGISTRATION

LARGE DISTRICT REGISTRATION:

Fill out the form below to get started.

Once registered, you’ll receive an email with instructions to log into your course portal.

Fill out the form below to get started.

Once registered, you’ll receive an email with instructions to log into your course portal.

Registration Form

PROMOTING ACCESS THROUGH HEALTH-INTEGRATED LEADERSHIP

An Advanced Professional Development Course

Contact Information

First Name *

Last Name *

Email *

Phone *

Professional Role *

Job Title *

Demographic Information

My education level *

Education Level - If you chose "Other," please share more details here:

Gender *

Female

Male

Other

Race and ethnicity - If you chose "Other," please share more details here:

School Information

School name *

School district *

City *

School community *

Urban

Suburban

Rural

School type *

Public

Private

Other

Grade levels I serve - If you chose "Other," please share more details here:

Additional Questions

How did you hear about Clinic to Classroom (C2C)? *

C2C website
Email
Colleague or friend
Parent or student’s family
Social media
Professional conference
Community event
Local CESA
Other

How well do you understand the potential health limitations of chronic illnesses and associated developmental delays, learning challenges, and lifetime attainment risks? *

0

5

10

Response scale: 0 to 10, where 0 = I wouldn’t know where to begin, 5 = I could make this connection for a few medical conditions, 10 = I’m an expert and I could explain these connections for any medical condition

I am signing up for this professional development course because... *

Questions for the coaches (Optional)

1.
2.
3.

Payment Details *

Large District Registration for Promoting Access Through Health-Integrated Leadership Virtual Course

An advanced professional development course.

$100000

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Who We Are

Bridging the Gap Between Health and Learning

We're School Success Coaches with firsthand experience navigating the intersection of health and education. We've sat at IEP tables, supported students managing complex medical needs, and witnessed the consequences of systemic gaps that leave too many behind. Now, we empower professionals like you to rewrite that narrative—through evidence-informed training, collaborative problem-solving, and leadership development grounded in lived expertise and interdisciplinary practice.

Email: [email protected]

Based out of Milwaukee, WI

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