If you’d like to hire me to speak at a conference or work with your school or district, please fill out the following form. I’ll receive your information in an email and will be back in touch promptly. If you’d like to send me an email about other matters, please click HERE to find my email address. Thank you for your interest!

Primary contact person (required)
First and Last Name

of Primary Contact

Cell Number (required)
of Primary Contact

Your Email (required)

School/Organization Mailing Address (for Contract and Invoice purposes) (required)
Street, City, State, Zip Code

School/Event Physical Address
*Only if different from Billing Address

Special Circumstances (required)
Are there special requirements for Contracting or Invoicing? Please specify or state none.

Preparing for Our Work Together
Any information you provide below will assist in planning for the needs of your staff and your goals for our work together.

Possible Date(s) (required)
List preferred dates or "open" if you have no preference. Typically a day is 6 hours with a 45 minute lunch break.

Who Would Be Involved? (required)
Please provide any information you can about the size of the audience,and grade levels or positions of educators who will participate.

Your District/Organization's Literacy History
Describe you past or current affiliations, models, priorities. Shifts in your district/organization. Strengths and struggles. And so on.

Previous Professional Development
What recent providers, speakers, etc. have your staff/participants engaged with? What books have they studied? Conferences attended?

Goals for Our Work Together (required)
Please describe how you see my work fitting into the goals of your district/organization. (The answer to this question will also help me evaluate if I am a best fit for your goals or if I can suggest someone else who may be. I want to support you and your staff/participants in having the most positive professional development experience possible).

Travel Information
Any information you can provide now will help me in arranging travel. You may also send this information at a later date.

Nearest Airport
Provide more than one if available.

Location of Professional Development
*If other than the School listed at the start of this survey, supply venue name, street address, city, state, zip code.

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