APD > Registration Form

APD Area 4

4-day Pre-Service Supported Employment Training


October 20 & 21, 2009

9:00 a.m. - 4:30 p.m.

Training is for all new APD providers of SE services

Your Contact Information

Please fill in all of the information below:
(* Denotes Required Field)

First Name:	*
Last Name:	*
Email Address:	*
Telephone Number:	*
Cell or Other Number:	*
SE Agency Name	*
If not working for an Agency, please state your reason for taking the classes (starting own business/agency or if not, what is your interest in taking the class?)	*

Class Schedule and Registration

Please select the training class that you would like to register for.

Once you have made your selection, please select the "Send Form" button at the bottom of the page. You should receive an email at the address you provided above confirming the receipt of your request.

You must print out the confirmation email and bring it with you the day of class.

** Class sizes are limited. Registration does not guarantee a seat in the class.

Supported Employment
Training	Date
4-day Pre-Service Supported Employment Training	October 20 & 21 and October 27 & 28