ACEPT 2018 Practicum Fair Site Registration Form
Friday December 7, 2018
Location: Roosevelt University, Second Floor
430 South Michigan Avenue at Congress

Itinerary:
8:30-9am registration on 2nd floor
9-9:30am Breakfast and ACEPT guidelines presentation in room AUD244
9:30-12 ACEPT site table open to students
12-12:30pm Break and Lunch for those who registered for the CE presentation
12:30-2pm CE Presentation in room AUD244

PLEASE RSVP VIA THIS FORM BY NOVEMBER 23, 2018.

Email address *
Please tell us about your training site:
Site Name
Your answer
Site Street Address
Your answer
City, State, and ZIP Code
Your answer
Name of Training Director
Your answer
Phone Number of Training Director
Your answer
Email Address of Training Director
Your answer
Supervisor That Will be Attending (limit of 2)
Your answer
Supervisor That Will be Attending (limit of 2)
Your answer
If there are multiple programs at your site (i.e. a consortium or hospital with various tracks) please indicate the names here so we may seat your tables near one another.
Your answer
Please list the number of openings you have for each practicum type:
MA
Your answer
Diagnostic
Your answer
Therapy
Your answer
Advanced
Your answer
I/O
Your answer
Art Therapy
Your answer
Registration Payment
Please select one payment choice below.
Will you be staying to attend the CE presentation by Drs. Yoko Mori and Stephanie Benedict titled "Supervision as an opportunity to model: Navigating the unfamiliar" after the fair from 12:30-2:00pm (lunch provided beforehand)?
If you need CE's for attending the presentation, please give the name of the attending person or persons.
Your answer
Thank you
Thank you for taking the time to complete the registration form. The next page will have information about the Practicum Fair as well as payment.
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