Exit Online Form

Autism Spectrum Disorder Awareness Series Application

First Name: *

Last Name: *

Address: *

Email Address: *

Telephone:

How did you hear about the Autism Spectrum Disorder Awareness Series? *

Workshops

Course Code	Topics	Start Dates	Instructor	Fee
ASD 100	What is Autism Spectrum Disorder	10/24/12	Dr. Anna Lamikanra	$159.00
ASD 200	Social / Cultural Issues	01/24/13	Dr. Anna Lamikanra	$159.00
ASD 300	Alternative Communication	04/24/13	Taramoni Muldrew Clark	$159.00
ASD 400	Support Network for Special Needs Providers	07/24/13	Tracey Wasai	$159.00
ASD 499	Portfolio Project	10/24/13	Dr. Adeola O. Fayemi	$159.00
All 5 Courses (Discounted Total, Pay all at once)				$725.00

Please select the workshop(s) you are applying for: * ASD 100 - What is Autism Spectrum Disorder | $159.00
ASD 200 - Social / Cultural Issues | $159.00
ASD 300 - Alternative Communication | $159.00
ASD 400 - Support Network for Special Needs Providers | $159.00
ASD 499 - Portfolio Project | $159.00
All 5 Courses | $725 (Discounted)

See information on how to pay below.

Payment Details

Option 1:
Send a Cashier’s Check or Money Order made payable to Paine College, Global Autism Technology Education (GATE) Program to the address below:

Paine College
Global Autism Technology Education (GATE) Program
1235 15th Street
Augusta, GA 30901

When transaction is complete, send an email to: autism@paine.edu or etetteh@paine.edu.

Need assistance with this form?