The Florida Department of Education (DOE) in collaboration with

The Partnership for Effective Programs for Students with Autism (PEPSA)

and

The Center for Autism and Related Disabilities (CARD)

presents

July 17 – 20, 2006

8:30 a.m. – 4:15 p.m.

Registration each day 8:00 - 8:30 a.m.

Comfort Inn Conference Center, Busch Gardens

820 East Busch Boulevard

Tampa, Florida 33612

(813) 933-4011

Directions to Location: Exit I -275 at the Busch Boulevard exit # 50

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Registration Information

Complete the registration form and submit no later than May 12, 2006 to:

Tanisha Dobney

Email:

FAX: 813-974-6115

Mail: USF CARD ▪ 13301 Bruce B. Downs Blvd. MHC 2113A ▪ Tampa, FL 33612

5th Annual Autism Summer Institute Registration Form

July 17-20, 2006

Comfort Inn Conference Center Busch Gardens

820 East Busch Boulevard

Tampa, Florida 33612

(813) 933-4011

Agenda at a Glance

REGISTRATION EACH DAY 8:00-8:30
Monday, July 17, 2006……….. / Keynote by Dr. Rose Iovannone on ABA in the Classroom
Tuesday, July 18, 2006……….. / a.m. Keynote by Julie Weatherly, Esq. on IDEA 2004
p.m. Keynote by Rebecca Klaw, MS, M.Ed. on Data Collection
p.m. (Administrators Only) – Julie Weatherly, Esq. on Legal Issues
Wednesday, July 19, 2006……. / a.m. Break Out Sessions
p.m. Break Out Sessions
Thursday, July 20, 2006………. / a.m. Break Out Sessions
p.m. Closing Keynote Address by Mary Jo Caruso, M.Ed. on Building Communities

Breakout Session topics: Mediation and Conflict, Building Community, Social Stories, Student Profile Binder, Work Systems, Asperger Syndrome, Literacy, Positive Educational Planning, Sensory Challenges, Teacher/Family Collaboration, Transition Services, Data Collection, Goals and Objectives

No Acronyms Please! Registrant Information No Acronyms Please!

Name / Work Phone / ()-
School Name
or Employer / FAX / ()-
City / Home Phone / ()-
County / Email
Are you Out-of-Field? Yes 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 use the legend below to complete the following information:

Job Title
School Type: / Class Type: / Certification:
Legend
Job title:
1. Elementary Teacher (K-5)
2. Middle School Teacher (6-8)
3. High School Teacher (9-12)
4. Multi-level Teacher (EL, MS, HS)
5. Itinerant Teacher (K-12)
6. PreKindergarten Teacher
7. Student (PK-12) / 8.  Family Member
9.  Paraprofessional
10.  Therapist (OT/ PT/ SLP)
11.  ESOL Teacher
12.  Title 1 Teacher
13.  District Program Staff
14.  Principal/Assistant Principal / 15.  Other School Professionals
16.  Behavior Specialist
17.  Social Worker
18.  Psychologist
19.  Counselor
20.  Nurse
21.  FDLRS Staff / 22.  Project Staff
23.  Other Agency Staff
24.  Undergraduate Student
25.  Graduate Student
26.  In State Col./ Univ. Staff
27.  Out of State Col./ Univ. Staff
28.  Other School Support / 29.  Bus Driver/Aide
30.  Substitute
31.  Private Consultant
32.  DOE Staff
33.  Preservice Teacher
sCHOOL tYPE: / Class Type: / Certification:
AA. Private
AB. Charter
AC. Public
AD. N/A / BA.  General Education
BB.  ESE, NOT Autism
BC.  Autism
BD.  N/A / CA. General Education
CB. Varying Exceptionalities
CC. Other ESE
CD. Not Certified
CE.  N/A /

Return registration form no later than May 12, 2006 to:

Tanisha Dobney

Email:

FAX: 813-974-6115

Mail: USF CARD ▪ 13301 Bruce B. Downs Blvd. MHC 2113A ▪ Tampa, FL 33612

A limited number of seats are available so register early. First come, first served!!!

All confirmations and/or reminders will be sent via email.