Responding to the Needs of Students with Autism Spectrum Disorders
3-Hour Seminar for NYS Social Worker CPE Credits
Registration Form
Name: _________________________________________________________
Street Address: __________________________________________________ County: _____________________
City: _____________________
Phone Number: (
State: ____________
Zip Code: ___________________
)____________________
Email Address: _________________________________________________________
School District/Agency: __________________________________________________
Position:
Licensed Master Social Worker (LMSW)
Licensed Clinical Social Worker (LCSW)
How did you learn about the course? (Please circle one)
CARD Website
NYSED
School District
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Other ________________
Payment Information (the cost of the training is $75):
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Please make checks payable to THE RESEARCH FOUNDATION FOR SUNY.
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Expiration Date: ________________________
Name as it appears on card: ___________________________________
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Signature: ______________________________________________________
Please return this form, with payment, to the address below. Once your payment has been processed, you
will receive an email from CARD with login information that will allow you to access the training. The
course will be accessible to you for 1 month upon issue of login information. You are required to complete all
course requirements as outlined in the training guidelines. Refunds will ONLY be issued upon a website or
system failure that cannot be corrected in a timely fashion.
Center for Autism and Related Disabilities • University at Albany
College of Arts and Sciences • Department of Psychology
1535 Western Avenue •Albany, NY 12203