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The TIM Academy Registration Form

Please enter the following information and click next. You may mail a purchase order or check to the address below or pay via Paypal on the next page: 

Michelle McGurl
The TIM Academy
973 Old Lancaster Rd.
Suite 100
Berwyn, PA 19312



Name:  
School District or Support Service Agency:
(If Applicable)
 
Address:  
City:  
State:  
Zip:  
Day Phone :  
Evening Phone :  
Email :  
     
Parent or Professional : Parent
Professional

 

How did you hear about our training? _____________________________________


I would like to attend:

Structured Teaching (Level I) - June 26th June 30th, 2017
Beyond the Basics (Level II)  
Changing Challenging Behaviors
Structured Teaching for the Included Child
Tour of the Timothy School  - Available Upon Request

 
Purchase Order or Check#:         
 
Years of experience with children diagnosed with autism 
Current position: 
Student Age range:            
 
* If you are a professional seeking ACT 48 hours, please provide the following information:
Pennsylvania Personal ID# :    OR
Date of Birth:   AND Social Security Number: 
 
 
The TIM Academy973 Old Lancaster Road, Suite 100, Berwyn, PA 19312(610) 644-2313Copyright 2008, All Rights Reserved