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Training/Certification Interest Form
About
Take Flight Retraining for CALTs Application
First name
*
Last name
*
District
*
Email
*
Phone
*
What is your ALTA Membership Number?
*
Is your district using Take Flight by Scottish Rite for Children?
*
Where did you receive your initial CALT training?
*
Who was your course director?
*
Who was your supervising QI?
*
Which dyslexia therapy programs have you used?
*
District Supervisor Name
*
Supervisor Email
*
Supervisor Phone Number
*
Please upload a copy of ALTA membership card here
*
Upload File
Please upload current proof of your CALT membership here
*
Upload File
Cost of training (requested upon submission of this application)
$
600
Submit
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