Service Providers Workshop - Registration Form

Please note that due to limited registration, the workshop might fill prior to the deadline dates. Registration will close as soon as the maximum number of participants is reached.

Please Note: Due to high demand in previous years, YOUR SPOT IS NOT GUARANTEED until we receive your registration fee.

Workshop session (choose one) *

Workshop session (choose one) Thursday, October 26th, 2017 Thursday, February 22nd, 2018
First name *
Last name *
Email where you can be contacted for confirmation of location *
Phone number (where you can be reached) *
Name of School *
Name of School Board *
Role *

Role Guidance Special Education Psychologist Clincian Other Other
Work Address Work Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
I am interested primarily in informatoin for student with

I am interested primarily in informatoin for student with Learning Disabilities (including ADHD, ASD) Students with Mental Health Disabilties Students with Physical, Sensory and Medical Disabilities
I am interested in more in depth information about

I am interested in more in depth information about assessments and documentation requirements for registration with disability services students with mental health disabilities and how they can be supported at the university students who have moblility and visual impairments who need additional supports students on the Autism Spectrum and the challanges that present at the univeristy and how they are supported students with learning disabilities and how they are supported at the university students who are deaf, deafened or hard of hearing and how they can be supported at the post secondary level students with ADHD and how they can be supported at the university
Coffee, tea, and mini pastries are provided at the morning start and break. A self-service hot/cold buffet is included as part of lunch. Please indicate any dietary restrictions/allergies and we will do our best to try and accommodate *
Payment *

Payment I agree to mail the $50 registration fee in the form of a cheque made payable to York University. Please send cheque to: Disability Services, Room W128 Bennett Centre for Student Services York University, 4700 Keele Street Toronto, Ontario, M3J 1P3 My principal/supervisor has asked that the school/school board be invoiced for the cost ($50) of the workshop (York's Finance Department will send the invoice directly to your school/school board)
If you have asked that the school/school board be invoiced, please provide the name and email address of an administrative contact
I am aware in submitting this form that: *

I am aware in submitting this form that: refunds will only be processed up to two weeks before the event. Once fees are processed there will be no refunds. the workshop registration fee does not include parking attendees will be issued a receipt for parking the day of the workshop)