Registration Information

Review and Submit Your Registration

Online Profile Information

User IDs and passwords must be at least 6 valid characters.
Valid characters include letters, numbers, dashes, underscores and periods.
Do not include spaces in your User ID or password.
User IDs and passwords are case sensitive.

User ID:

Password:

Confirm Password:

Contact Information

Application Type:

Salutation:

Mr. Ms. Mrs. Dr. Miss Not Specified

First Name:

Middle Name:

Last Name:

Suffix:

None Jr. Sr. III IV

Mailing Address

Address:

Address 2:

Address 3:

City:

State:

Zip/Postal Code:

Primary Phone: (nnn-nnn-nnnn)

Alternate Phone: (nnn-nnn-nnnn)

Email:

General Education Information

Highest Degree:

Year Degree Attained:

University Where Degree Attained:

TSVI Education Information

How did you receive your TSVI education?:

University TSVI/TVI program

Alternative VI certification as TSVI/TVI

Passed a state TSVI/TVI credentialing exam without specific training

Licensing and Work Experience

License #1 State:

In what roles are you employed? (check all that apply)

Teacher

Administrator

Personnel Prep

Consultant

Other

As of the date of your registration, how many years have you been teaching as a TSVI/TVI:

TSVI Public Registry OPT-OUT

All of the information in the Registry will be completely private to the public except your name and the state(s) where you are licensed.

All of the additional information that you provide will be confidential and only known to Success Beyond Sight (SBS). The additional information will be used by SBS for research to advocate for both the funding needed to train and support this very important profession and to ensure sufficient funding for all of the students who require your specialized services. It will provide a national forum for reaching you with important information and for providing you with opportunities, if you choose, to be included in important surveys and research to benefit your profession.

If, for any reason of personal security, you do not want your name and state(s) where you are licensed included in the public directory, you may opt out now.

I want to OPT-OUT of the public registry

Attestation

I attest that all of the information I have provided here is true and correct.

Signature: (Type full name)