Registration Form - March 24, 2017 Workshop "Building Trauma Informed Schools "
The completed registration form for this event is due no later than March 17th
Workshop Overview
Thank you for your interest in this professional development workshop offered by the School Counseling & School Psychology Institute with support from the School Counseling Programs Counselor Education at Assumption College.

"Building Trauma Informed Schools " will be held on Friday, March 24, 2017 from 8:30am - 2:30pm in the Hagan Campus Center at Assumption College. We will be joined by Dr. Stephanie Eberts from Louisiana State University for this workshop.

This is meant to be an interactive workshop, welcoming questions throughout the day to better serve your professional development needs. Please feel free to bring a laptop, tablet, or iPad to the event as WiFi access will be available as well.

Parking will be available in the visitor parking ramp on campus. A campus map and directions to the college are available by contacting the Director, Dr. Theresa Coogan (ta.coogan@assumption.edu). Additional important details about the workshop will be shared with attendees via the email used on this registration form closer to the event date.

All attendees must complete the form below registration for this event in advance. Space is limited, and walk-in registrations may not be guaranteed. Payment in full is required for admissions into the workshop. Payments are encouraged well in advance of the workshop date to assist with this policy.

All attendees will receive a certificate of attendance for continuing education credits at the end of the workshop. In collaboration with the Counseling Psychology Program at Assumption College, the School Counseling & School Psychology Institute is recognized as an NBCC-Approved Continuing Education Provider (ACEP) and may offer NBCC-approved clock hours for events that meet NBCC requirements. The ACEP solely is responsible for all aspects of the program. Certificates of Attendance are available for School Practitioners to use towards PDP’s and Continuing Education Units (CEU’s) are available for clinical practitioners. CEU's may be also used towards the collection of Professional Development Points's (PDP's) for counselors documenting continuing education through the Department of Elementary and Secondary Education (DESE) in the Commonwealth of Massachusetts. Information about PDP requirements and processes should be directed to DESE.

Full Name
(as you would like it to appear on the certificate of attendance)
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Preferred e-mail (details of the workshop will be communicated through this modality)
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Occupation
Place of full-time Employment
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Lunch will be provided to attendees. Do you have any dietary restrictions we should be made aware of?
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Do you have any other accommodations we can assist with?
Your answer
Registration Rates & Processes
A registration for each individual attendee is required. The registration rates for the 2016-2017 workshops are as follows:

Professional - $75.00
Professional & Current Site Supervisor/Adjunct Faculty for 2015-2016AY - $50.00
Professional & Alumni from Assumption Graduate Program - $50.00
Graduate Student (non-Assumption, with valid ID at door)- $25.00
Graduate Student (Assumption, with valid ID at door ) - complimentary


Methods of payment accepted:
1) Personal check
2) Money Order/Cashier's Check
3) Cash
4) Online payments -- Electronic Debit & Credit Card payments through the following website that is affiliated with Assumption College*

*Online payments may be made through https://assumption.afford.com/paynow?storeid=814. Note: If you do not have a student ID, enter any random seven digit number starting with ‘0’. Please be advised a convenience fee will likely charged automatically for credit and debit card purchases. If using the electronic option from a checking account to manually enter your routing number, there is said to be no additional fee. Please be advised this is a 3rd party vendor for the college and not used exclusively for our workshops. For additional assistance about this payment method, please contact the Assumption College Cashier’s office at 508-767-7412.


Submit Payment in Advance no later than March 17th by mail to ensure it is received before the workshop:

The School Counseling & School Psychology Institute
Assumption College, Kennedy 163
500 Salisbury Street
Worcester, MA 01609

Payments may be accepted in bulk. Please contact the Director, Dr. Theresa Coogan (ta.coogan@assumption.edu) to update of this intent so we may be sure our registration forms are updated accordingly to reflect payment of all attendees.

All registrations must be paid in full for each attendee who is registered to participate in the workshop. Any registrations that are not paid in full may be voided to allow space for another attendee. Space is limited and wait lists will be created for events. We will attempt to provide updates about space on the website (http://goo.gl/3B9OWi). Please help us by completing the registration form and submitting payment in advance.

Day of the event, there will be a registration table for attendees to check in and receive the materials and name badge for the workshop.

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