REGISTRATION FORM

Indicate Your Choice(s) of Workshops by marking X in the box and Print Clearly the names of participants, their phone, fax and e-mail (if available) on page 2. Participants will be notified only if the workshop has already reached capacity. If you have any questions or need further information, contact Bryan Ayres at the Easter Seals Outreach Program at 501-227-3770.

Topic:Consideration & Assessment for Assistive Technology

DateLocations

10/24/00Arkansas Department of Education Distance Learning Lab, 8221 Ranch Blvd.,

Little Rock, AR 72223, 501-371-5008Capacity: 25

10/24/00Southwest AR Education Service Cooperative, 500 South Spruce,

Hope, AR 71801, 870-777-3076Capacity: 20

10/24/00DeQueen/Mena Educational Cooperative, 305 S. Hornburg,

Gillham, AR 71841, 870-386-2251Capacity: 25

10/24/00Dawson Education Service Cooperative, 711 S. Clinton Street,

Arkadelphia, AR 71923, 870-246-3077Capacity: 25

(Distance Learning Lab is on the 2nd floor of Caplinger Hall at HSU)

11/14/00Arkansas Department of Education Distance Learning Lab, 8221 Ranch Blvd.,

Little Rock, AR 72223, 501-371-5008Capacity: 25

11/14/00Ozarks Unlimited Resources Cooperative, 525 Old Bellefonte Road

Harrison, AR 72601, 870-743-9100Capacity: 20

11/14/00Northwest Arkansas Education Service Cooperative, 409 N. Thompson

Springdale, AR 72764, 501-756-2803Capacity: 24

11/14/00Western Arkansas Education Service Cooperative, 3010 East HWY 22

Branch, AR 72928, 501-965-2191Capacity: 18

11/14/00Arch Ford Education Service Cooperative, 101 Bulldog Drive

Plumerville, AR 72127, 501-354-2269Capacity: 25

12/6/00Arkansas Department of Education Distance Learning Lab, 8221 Ranch Blvd.

Little Rock, AR 72223, 501-371-5008Capacity: 25

12/6/00Great Rivers Cooperative, Campus Drive

Helena, AR 72390, 870-338-6461Capacity: 18

12/6/00Southeast Arkansas Education Service Cooperative, 1022 Scogin Drive

Monticello, AR 71655, 870-367-6848Capacity: 30

12/6/00Arkansas River Education Service Cooperative, 912 W. 6th Avenue

Pine Bluff, AR 71601Capacity: 20

12/6/00Wilbur D. Mills Education Service Cooperative, 210 North Main

Beebe, AR 72012, 501-882-5467Capacity: 16

Page 2

REGISTRATION FORM

Topic:Consideration & Assessment for Assistive Technology

1/9/01Arkansas Department of Education Distance Learning Lab, 8221 Ranch Blvd.,

Little Rock, AR 72223, 501-371-5008Capacity: 25

1/9/01Northcentral Arkansas Education Service Cooperative, 1013 Haley,

Melbourne, AR 72556, 870-368-7955Capacity: 25

1/9/01Northeast Arkansas Education Service Cooperative, 211 W. Hickory,

Walnut Ridge, AR 72476, 870-886-7717Capacity: 20

1/9/01Crowley’s Ridge Education Cooperative, 203 South Illinois,

Harrisburg, AR 72432, 870-578-5426Capacity: 20

1/9/01South Central Service Cooperative, 400 Maul Road,

Camden, AR 71701, 870-836-2213Capacity: 30

NameRole/TitlePhone #Fax #E-mail

______

______

______

______

Please mail or fax the completed forms to:Bryan Ayres, Education Consultant

Easter Seals Outreach Program

3920 Woodland Heights Road

Little Rock, AR 72212

Fax: 501-227-3771

REGISTRATION FORM

Indicate Your Choice(s) of Workshops by marking X in the box and Print Clearly the names of participants, their phone, fax and e-mail (if available) on this page. Participants will be notified only if the workshop has already reached capacity. Lunch will be on your own at all locations. If you have any questions contact Bryan Ayres at the Easter Seals Outreach Program at 501-227-3770.

Topic:Assistive Technology & Communication Issues

DateLocation

11/16/00Easter Seals Outpatient Service Building, Sturgis Room

3920 Woodland Heights Road, Little Rock, AR 72212, 501-227-3600

(Directions: From I-430 take the Cantrell/Hwy 10 exit. Turn west. Go through the first light “Rodney Parham”. Turn left at the next street on Woodland Heights Road, “Shell QuikStop & Popeye’s Chicken” and follow this street as it winds around. When you approach a stop sign you will be at Easter Seals of Arkansas.

12/12/00Northeast Arkansas Education Service Cooperative, 211 W. Hickory

Walnut Ridge, AR 72476, 870-886-7717

2/6/01Harvey & Bernice Jones Center for Families, Springdale, AR 72764, 501-756-8090

2/23/01Southeast Arkansas Education Service Cooperative, 1022 Scogin Drive

Monticello, AR 71655, 870-367-6848

3/6/01Southwest Arkansas Education Service Cooperative, 500 South Spruce

Hope, AR 71801, 870-777-3076

NameRole/TitlePhone #Fax #E-mail

Please mail or fax the completed forms to:Bryan Ayres, Education Consultant

Easter Seals Outreach Program

3920 Woodland Heights Road

Little Rock, AR 72212

Fax: 501-227-3771

REGISTRATION FORM

Indicate Your Choice(s) of Workshops by marking X in the box and Print Clearly the names of participants, their phone, fax and e-mail (if available) on page 2. Participants will be notified only if the workshop has already reached capacity. Lunch will be on your own at all locations. If you have any questions, contact Bryan Ayres at the Easter Seals Outreach Program at 501-227-3770.

Topic: Access to the Curriculum via the Use of Assistive Technology

DateLocation

10/17/00Dawson Education Service Cooperative, 711 Clinton Street

Arkadelphia, AR 71923, 870-246-3077

11/21/00Southwest Arkansas Education Service Cooperative, 500 South Spruce

Hope, AR 71801, 870-777-3076

12/5/00Arch Ford Education Service Cooperative, 101 Bulldog Drive

Plumerville, AR 72127, 501-354-2269

1/11/01Western Arkansas Education Service Cooperative, 3010 East HWY 22

Branch, AR 72928, 501-965-2191

1/23/01DeQueen/Mena Educational Cooperative, 305 South Hornburg

Gillham, AR 71841, 870-386-2251

2/13/01Wilbur D. Mills Education Service Cooperative, 210 North Main

Beebe, AR 72012, 501-882-5467

2/20/01AR River Education Service Cooperative, 912 W. 6th Avenue

Pine Bluff, AR 71601, 870-534-6129

2/28/01Great Rivers Cooperative, Campus Drive

Helena, AR 72342, 870-338-6461

3/6/01Crowley’s Ridge Educational Cooperative, 203 South Illinois

Harrisburg, AR 870-578-5426

3/13/01Northeast Arkansas Educational Cooperative, 211 W. Hickory

Walnut Ridge, AR 72476, 870-886-7717

4/10/01Northcentral Arkansas Education Service Center, 1013 Haley

Melbourne, AR 72556, 870-368-7955

4/17/01Northwest Arkansas Education Service Cooperative, 409 N. Thompson

Springdale, AR 72764, 501-756-2803

(The NWARESC charges a $5 user fee for the use of the computer lab. Participants must pay NWARESC on site)

4/24/01Southeast Arkansas Education Service Cooperative, 1022 Scogin Drive

Monticello, AR 71655, 870-367-6848

Page 2

REGISTRATION

Topic: Access to the Curriculum via the Use of Assistive Technology

5/1/01Ozarks Unlimited Resources Cooperative, 525 Old Bellefonte Road

Harrison, AR 72601, 870-743-9100

5/8/01South Central Service Cooperative, 400 Maul Road

Camden, AR 71701, 870-836-2213

NameRole/TitlePhone #Fax #E-mail

Please mail or fax the completed forms to:Bryan Ayres, Education Consultant

Easter Seals Outreach Program

3920 Woodland Heights Road

Little Rock, AR 72212

Fax: 501-227-3771