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University of New Mexico Center for Development and Disability. A University Center for Excellence in Disability Education, Research, and Service

SWAN Course Registration

Course Registration Form

I am registering for the course:

Check here if you are a parent or caregiver of an affected child:

First:
Last:
Address:
City:
State:
Zip:
Daytime Phone:
Evening Phone:
Email Address:
Fax Number:
Occupation:
School District or Agency:
Title:

I'm taking this course for:
Credit
CEUs
Non-Credit

I am taking this course under the auspices of a DOH provider program (enter agency name here):

 

   

Supervisor's Email Address:

I am enrolling in a free or non-payment course.

I understand that I am registering with the Autism Program to attend the Family and Communication Education (FACE) workshop. I also accept responsibility for the training fee ($65 per person, per workshop) and will make arrangements to send payment to the University of New Mexico.

My school district is assuming the cost of this course (provide Purchase Order below).
Purchase Order #:

 

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University of New Mexico Center for Development and Disability
2300 Menaul Blvd NE, Albuquerque NM 87107
Phone: 505.272.3000 | Fax: 505.272.5280 | Email: cdd@unm.edu