Facilitator Refresh

1Event Select

2Facilitator Information

Name*
First Last
Address*
Please enter your HOME address. You should not enter your school address.

Street Address Address Line 2 City State Zip Code
Phone*
*Please be sure to add your mobile number. We will only be using this to connect with you during the event and if additional support is needed.
Email*
School Staff Type*
T-Shirt Size*
Professional Personal Identification Number (PPID) for ACT 48 Hours*
Please provide your identification number given by PA DOE. Find your PPID HERE - https://www.perms.pa.gov/Screens/wfProfessionalPersonnelID.aspx . If you DON'T have a PPID, please enter 0.
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