Paul V. Sherlock Center on Disabilities

Introduction to Early Intervention Fall 2025

Register only one person per form.

April 7, 8, 28 & 29, 2026
8:30 a.m.-3 p.m.

Attendance at all four (4) days is required.

Event ID: Add assigned Event ID from the Event Database in "Default Answer"

SMEStudentID:

1. Today's Date: *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Session A:

Session B:

CONTACT INFORMATION

2. First Name: *This question is required.

3. Last Name: *This question is required.

4. Title: *This question is required.

5. Address 1: *This question is required.

Address 2: (if needed)

6. City: *This question is required.

7. State: *This question is required.

8. Zip Code: *This question is required.

9. Phone: (xxx-xxx-xxxx) *This question is required.

10. Cell Phone: (xxx-xxx-xxxx) This question requires a valid number format.

11. Email Address: *This question is required. This question requires a valid email address.

12. Re-enter Email Address: *This question is required. This question requires a valid email address.

13. Accommodation Request: Use the space below to request a reasonable accommodation (e.g., ASL interpreter, large print, special dietary request for medical reasons), or to request information in a language other than English. To make a request after submitting this form, contact Tracy Miller tmiller1@ric.edu or 401-456-8072.

Supervisor Contact Information *This question is required.

Supervisor First Name

Supervisor Last Name

Supervisor Email *This question is required. This question requires a valid email address.

Re-enter Supervisor Email *This question is required. This question requires a valid email address.

How long have you been employed in EI? *This question is required.

If other, list discipline:

What is your role within your program? Check all that apply. *This question is required.

Service Coordinator
Evaluation Team Member
Other

If other, describe your role within your program:

Please list below any specific questions or issues you would like addressed at the training? LEAVE BLANK IF YOU HAVE NO QUESTIONS.

Affiliation:

Fee Waived Explain:

PAYMENT AGREEMENT: I understand registration* to this workshop holds me responsible for payment of the $XXX registration fee.

*Note: Registration fees will not be refunded for registrations processed or cancelled after XXXX, however, you may transfer the registration to another member or your organization or family.

Billing Contact:

Billing Information:

Billing Agency:

Billing Address:

Billing City:

Billing State:

Billing Zip Code:

Billing Email Address: This question requires a valid email address.

Confirming Billing Email Address: This question requires a valid email address.

DEMOGRAPHICSThe Sherlock Center collects demographic data to include in state/federal reports and grant applications. The Sherlock Center reports data in a non-identifying manner. Participation is voluntary.

What other term do you use to describe your gender?