The Independent, Federally-Mandated Protection and Advocacy System for People with Disabilities in Georgia

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Parent Leadership Support Interest Questionnaire

Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email
Phone
Which of these cities would you travel to in order to participate in the PLSP training? Please check at least one.
- Macon
- Savannah
- Athens
- Metro Atlanta
- Augusta
- Albany
- Valdosta
- Bainbridge
Please check all that apply: I am a:
- Self Advocate
- Family member of a person with a disability
- Service Provider
- Concerned
- other
What weekday(s) are you available to participate in the project?
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
What topics are you most interested in learning about?
Do you know of any groups that are natural allies, who may want to join, collaborate, participate in or host a training event (faith-based organizations, community organizations, civil rights organizations, etc.)?

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