09-10 Leadership Academy for Counselors (Cohort 1) Survey

09-10 Leadership Academy for Counselors (Cohort 1)


The Leadership Academy for Counselors (LAC) will provide you with the opportunity to become very familiar with all of the aspects of a school campus in order to build a stronger and more informative counseling presence at your school. Please fill out the following form to provide us with your enrollment information:

1.	First Name*

2.	Last Name*

3.	ESC-20 iLearning User Name (if known)

4.	School District*

5.	Campus*

6.	Work Phone Number*

7.	E-Mail Address*

8.	Billing Street Address*

9.	City/State*

10.	Zip Code*

11.	Method of Payment:* (Please select one payment method below)
	Individual Check Individual Credit Card Campus PO District PO
	If paying by PO or check, please provide the Check# or PO#:

Please print a copy of this application and send it to the ESC-20 Business Office along with the LAC fee of $425.00 (payable by check or purchase order):

ESC-20 Business Office
1314 Hines Ave.
San Antonio, TX 78208

If you would like to pay by credit card (Visa and Mastercard are accepted) please contact us at (210) 370-5212.

If you have any questions about this program, please contact Pamela Chambers at: pamela.chambers@esc20.net or by phone: (210) 370-5730.