MEMBERSHIP APPLICATION

Mission Statement

"LaTEACH promotes appropriate, inclusive education for all students. We work to make parents, educators, the general public, and state leadership informed and supportive of research based and effective practices used appropriately for each student."

Full Name
Address
Address (Cont'd)
City
Parish	Acadia Allen Ascension Assumption Avoyelles Beauregard Bienville Bossier Caddo Calcasieu Caldwell Cameron Catahoula Claiborne Concordia De Soto East Baton Rouge East Carroll East Feliciana Evangeline Franklin Grant Iberia Iberville Jackson Jefferson Jefferson Davis La Salle Lafayette Lafourche Lincoln Livingston Madison Morehouse Natchitoches Orleans Ouachita Plaquemines Pointe Coupee Rapides Red River Richland Sabine St. Bernard St. Charles St. Helena St. James St. John the Baptist St. Landry St. Martin St. Mary St. Tammany Tangipahoa Tensas Terrebonne Union Vermilion Vernon Washington Webster West Baton Rouge West Carroll West Feliciana Winn
Zip Code
Home Phone
Work Phone
Fax Phone
Email Address
Check One: Individual receiving special education services Parent/Family Member of individual receiving special education Educator/Advocate Other interested person
I am willing to: (Check all that apply) Write letters Make phone calls Visit legislators, educators, Board Members Travel for meetings or hearing when my schedule allows Work as an Area Coordinator if needed