Special Ed./Behavior Management

Texas Behavior Support Initiative (TBSI) On-Line Training Registration Form

First Name

Last Name

Campus

District

To Receive Credit Hours For Module(s) Completed:

FAX the evaluation form(s) for each module completed to: Lenora Peterson FAX: 325-675-8659 / Check all that apply.

		Module 1-Legislative Issues #007249
		Module 2-Schoolwide/Classroom Interventions #007250
		Module 3-Indivual Interventions #007251
		Module 4-Time-out #007252
		Module 5-Prevention / De-Escalation Techniques #008029
		Module 6-Action Planning #008030

Campus Phone Number

Home Address

City, State Zip

E-mail Address