The TIM Academy Registration Page


	Structured Teaching Workshops

	Staff Development At Your Site

	2011 – 2012 Program Schedule

	Register Now

	Course Faculty

	Frequently Asked Questions

	Directions

	Contact Us

	>>Go To The Timothy School Web site

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 25 - June 29, 2012 Beyond the Basics (Level II) - 2012 Dates Coming Soon Changing Challenging Behavior - 2012 Dates Coming Soon Structured Teaching for the Included Child - 2012 Dates Coming Soon 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: