FREE Regional Workshop in ClayCounty…Jacksonville!

April 27, 2006

8:30a.m. – 4:00p.m.

Registration begins at 8:00a.m.

CelebrationChurch

512 Kingsley Avenue

Orange Park, Florida32073

CelebrationChurchis located at 512 Kingsley Avenue, Orange Park. For directions from your residence, visit .

For more information contact: CARD at (904) 737-5239 or you can send an email to Jeannie Bowles at

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Be sure to contact your ESE District Staff or Staff Development Contact to determine the process for receiving in-service.

Registration Information

REGISTRATION IS MANDATORY……DEADLINE: April 24, 2006

Complete the attached registration form and submit to Jeannie Bowles at UF CARD

Email:

Mail: University of Florida at Jacksonville, CARD Center, 6026 San Jose Boulevard, Jacksonville, Florida 32217

Fax: 904-396-4718

*All confirmations and/or reminders will be sent via email

Regional Training Registration Form

Please complete ALL sections of this form and submit. All confirmations and/or reminders will be sent via email.

Training Information

CARDCenter Hosting Training

Florida Atlantic University (FAU) CARD

Florida State University (FSU) CARD

University of Central Florida (UCF) CARD

University of Florida- Gainesville (UF GV) CARD

University of Florida- Jacksonville (UF JAX) CARD

University of Miami (UM) CARD

University of South Florida (USF) CARD

Training Title / Building Social Relationships: A Systematic Approach for Teaching Social Interaction Skills to Children and Adolescents with Autism Spectrum Disorder
Training Date / April 27, 2006

Registrant Information

No Acronyms Please

Name / Work Phone / ()-
School Name
or Employer / FAX / ()-
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

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Please use the legend below to complete the following information:

Job Title
School Type: / Class Type: / Certification:
Legend
Job title:
  1. Elementary Teacher (K-5)
  2. Middle School Teacher (6-8)
  3. High School Teacher (9-12)
  4. Multi-level Teacher (EL, MS, HS)
  5. Itinerant Teacher (K-12)
  6. PreKindergarten Teacher
  7. Student PK-12
/
  1. Family Member
  2. Paraprofessional
  3. Therapist (OT/ PT/ SLP)
  4. ESOL Teacher
  5. Title 1 Teacher
  6. District Program Staff
  7. Principal/ Assistant Principal
/
  1. Other School Professionals
  2. Behavior Specialist
  3. Social Worker
  4. Psychologist
  5. Counselor
  6. Nurse
  7. FDLRS Staff
/
  1. Project Staff
  2. Other Agency Staff
  3. Undergraduate Student
  4. Graduate Student
  5. In StateCol./ Univ. Staff
  6. Out of StateCol./ Univ. Staff
  7. Other School Support
/
  1. Bus Driver/ Aide
  2. Substitute
  3. Private Consultant
  4. DOE Staff
  5. Preservice Teacher

sCHOOL tYPE: / Class Type: / Certification:
AA.Private
AB.Charter
AC.Public
AD.N/A / BA.General Education
BB.ESE, NOT Autism
BC.Autism
BD.N/A / CA.General Education
CB.Varying Exceptionalities
CC.Other ESE
CD.Not Certified
CE.N/A