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*

Please upload current proof of your CALT membership here*

Cost of training (requested upon submission of this application)

$600

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