[dynamichidden form-type "registration"]
First Name *
[dynamictext* first-name "wpm_username"]
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[dynamictext* last-name "wpm_userlastname"]
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[dynamictext* your-email "wpm_useremail"]
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Please indicate your role: *
Teacher-in-trainingEA / SEA / CEA studentCommunity support (describe below)Parent / family
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program of study, etc:
Level of student(s) with whom you work
(choose only ONE - if both apply, select the
level with which you work the most): *
Elementary / Middle SchoolSecondary
Do you currently work directly with a child
/ children with ASD?
If ``yes``, please describe below: *
Describe your experience working with a
child / children with ASD:
In 2 or 3 sentences, explain why you are
interested in taking this course:
Which session of the Introduction to Autism
Spectrum Disorders - Practical Applications
course are you applying for?: *
June 19-23, 2017 (8 remaining)
REMINDER: THIS IS AN APPLICATION ONLY. SUBMISSION OF THIS FORM DOES NOT CONSTITUTE REGISTRATION.
YOU WILL BE CONTACTED BY POPARD TO PROCESS YOUR REGISTRATION AND PAYMENT IF YOUR APPLICATION IS
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Course Registration/Administration Fees are non-refundable.
Course attendees must attend the entire training session in order to receive a certificate of participation.
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[dynamichidden user_id "wpm_userid"]
[dynamichidden course_id "wpm_courseid"]
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