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Illinois RCEP Online
Orientation to Rehabilitation
March 10 - May 2, 2008
and/or
Social Skills in the Workplace
April 14 - June 6, 2008
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Registration
Form |
- Bold items are
required.
- Please send a
separate registration form for each participant.
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First
Name:
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Last Name:
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Job Title:
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Organization:
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Supervisor
Status:
No, I do not have a supervisor.
Yes, I have a supervisor (Please provide your supervisor's name, phone
number, and e-mail.)
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Mailing
Address1:
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Mailing
Address2:
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City:
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State:
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Zip:
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Phone
(Required) :
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Fax:
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Email
(Required):
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| NOTE: If you do not
provide your email address and phone number we cannot confirm your registration.
Your space may not be held at the event.
Web site:
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Please check if you want to subscribe to the free electronic RSA Region
V listserv. |
Please check if you require special assistance to fully participate. Please
describe your needs in the box below.
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Yes, I want CRC credit.
Yes, I want CEU credit. |
Please select one or both:
March 10 - May 2, 2008
- Orientation to Rehabilitation:
$90 per participant ($45 refund or credit for those who complete the
course in its entirety).
April 14 - June 6, 2008 - Social Skills in the Workplace: $90 per participant
($45 refund or credit for those who complete the course in its entirety).
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Payment
Method:
Please make checks/purchase orders payable to the University
of Illinois.
Check in the mail.
Purchase Order. Please provide purchase order number.
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What
other types of training are of interest to you?
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If
you are having problems submitting this form online,
please
click
here to print and mail or fax form to:
RSA
Region V CRP-RCEP
Transition Research Institute
ATTN: Betty Taylor
117 Children's Research Center
51 Gerty Drive
Champaign, IL 61820
phone: 217-333-2325
TTY 217-244-7132
Fax 217-244-0851
http://www.ed.uiuc.edu/illinoisrcep
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