AUTISM SUMMER WORKSHOP SERIES: “THE PIECES OF THE EMPLOYMENT PUZZLE: UNLOCKING PASSIONS THROUGH TRANSITION & CAREER ASSESSMENT”

July 24, 2009, 9:00 am – 4:00 pm


First Name :
 
Last Name :
School/Employer:
 
Work Phone:
City :
 
Home Phone:
County:
 
Email:
*Are You Out-of-Field? YES/NO
 
*Out-of-Field refers to a teacher in a district school system assigned to teach outside the area in which he or she was certified
Job Role:
Class Type:
School Type:
Primary Work:
What is your current school grade? (A,B,C,D or F)
 
Do you have an endorsement certificate in Autism ?
Y/N
 
Do you have an endorsement certificate in Severe and Profound disabilities ?
Y/N
 
If not, are you in the process of completing an endorsement certificate ?
Y/N