The Coalition of Mainstream Employment Programs

Online Registration - Job Coach II
February 28 & March 1, 2007

 
TITLE OF COURSE
DATE OF COURSE
Your Name (incl. credentials and academic degrees)
Home Phone (used for emergency)
Length of time in current position years     In Rehabilitation field    years
Job Title
Supervisor
Company Name
Company Mailing Address
City  State   Zip 
Business Phone
Fax   email 

Do you need material in alternate format?

 Braille 
Disk (for computerized reader program only) Large Print, specify font/size
Sign Language Interpreter  Closed Captioning 
Assistive Listening Device, please specify 

To make your training as comfortable and successful as possible, what type of assistive devices/services do you currently use?
Motorized Wheelchair  Manual Wheelchair
Scooter 

Guide Dog 

Personal Aide Other, please specify 

 


Online Registration by Web Strategies