Community Education
Epilepsy Foundation New England offers a variety of educational programs to promote public education/awareness and improve acceptance of people with epilepsy.
Parent Name
*
First Name
Last Name
Parent Email
*
example@example.com
Parent Mobile Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Child's Name
First Name
Last Name
Child's Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grade
*
What type of Epilepsy Foundation Training would you like us to do?
*
Seizure First Aid Training for Parents or non school personnel (could be work place)
My Friend Matty (A curriculum for Pre-K -3 grade)
Take Charge of the Facts (Educating High School students about epilepsy)
Take Charge of the Facts JR (Educating Jr High School students about epilepsy)
Seizure Training for School Personnel (all school staff, principals, teachers, para professionals, cafeteria, school bus, etc)
Seizure Training for Child Care (Nursery, day care, pre-school)
School Name
School District
Additional Information and/or Comments
Please verify that you are human
*
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