Name *

First Name

Last Name

Phone *

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What services are you interested in?

Collegiate Offerings

Workshops for In-Service Teachers

Workshops for Pre-Service Teachers

Workshops for Community Based Organizations

Classroom or Home Environment Consultation

Website Design

I understand that Ashley Copperstone can only work in-person with clients in Michigan and New York. *

Yes

I understand that booking and attending a consultation is an opportunity for Ashley and my program to get to know each other and see if we may be a good match; this does not guarantee that Ashley will be able to take me on as a client or provide other professional services and does not constitute as an immediate working relationship. *

Yes

I acknowledge and accept the risks of communicating my information via this form on this web portal and via unencrypted email; I wish to continue despite the risks. *

Yes