DOE Partnership

Registration: STRATEGIES FOR EDUCATING TEENS WITH AUTISM SPECTRUM DISORDERS (ASD)

First Name :		Last Name :
School/Employer:		Work Phone:
City :		Home Phone:
County:		Email:

Are You Out-of-Field? (Yes* or No) *Out-of-Field refers to a teacher in a district school system assigned to teach outside the area in which he or she was certified. Please answer using complete words (YES or NO).

Job Role:	Class Type:
School Type:	Primary Work:

What is your current school grade?
Do you have an endorsement certificate in Autism?	Yes No
Do you have an endorsement certificate in Severe and Profound disabilities?	Yes No
If not, are you in the process of completing an endorsement certificate?	Yes No

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