Florida Department of Education Center for Autism and Related Disabilities

FREE Regional Workshop in OrangeCounty!

Friday, December 9, 2005

Holiday Inn – Universal Orlando Registration: 8:00-8:30 am

5905 Kirkman Road, Orlando, FL32819 Workshop: 8:30 am-4:00 pm

Lunch: 12:00-1:00pm (on your own)

Directions to Holiday Inn-Universal Orlando:

FROM ORLANDO INTERNATIONAL AIRPORT
Exit Airport and follow signs to 528 West (Beeline Expressway). Take 528 West to Interstate 4 East. Exit on #75B (left side of road) from Interstate 4. Turn right at the first traffic light - Major Boulevard. The hotel is on the right.

FROM FLORIDA TURNPIKE
Follow the Turnpike to the Interstate 4 Exit. Take the first exit on right - #75B from Interstate 4. Turn right at the first traffic light - Major Boulevard. The hotel is on the right.

FROM INTERSTATE 4
Exit on #75B from Interstate 4. Turn right at the first traffic light - Major Boulevard. The hotel is on the right.

FROM INTERSTATE 95
Exit on #77B going West on 528 (Beeline Expressway). Take 528 West to Interstate 4 East. Exit on #75B from Interstate 4. Turn right at the first traffic light - Major Boulevard. The hotel is on the right.

For more information contact: Irene Mazloom at 407 737-2566 or

------Registration Information

REGISTRATION IS MANDATORY……DEADLINE: December 2, 2005

Seating is limited to the first 150 people

Complete the attached registration form and submit to UCF- CARD

Email:

FAX: 407 737-2571

Mail: University of Central Florida-Center for Autism▪ 12001 Science Drive, Suite 145▪ Orlando, Fl 32826

*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 / Social Thinking Across the Home and School Day:The ILAUGH Model of Social Cognition
Training Date / Friday, December 9, 2005

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

------

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. Pre-service 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