Training Registration Form

South Carolina Assistive Technology Program
Training Registration Form

Please email Sally.Young@uscmed.sc.edu or call (803) 935-5263 with questions.

Workshop:
Name:
Job Title:
Organization:
Address:
Check One:	Individual with disability Family member, guardian, or authorized rep. Representative of Education Representative of Employment Representative of Health, allied health, and rehab Representative of Technology Other
Work County:
Home County:
Daytime Phone:
Fax Number:
Email Address: (required)
What, if any accommodations do you need? (Please give us 10 days advance notice.)

South Carolina Assistive Technology Program
USC School of Medicine • Center for Disability Resources
University Center for Excellence, Columbia SC 29208

located at Midlands Center, 8301 Farrow Road, Columbia SC 29203
(803) 935-5263 • (803) 935 5342 fax • (800) 915-4522 toll free

This page was updated on February 23, 2011

If you have problems accessing this website, please contact Janet Jendron at Janet.Jendron@uscmed.sc.edu or complete our website feedback survey, which will help us improve the content and accessibility of this site.

Training Registration Form

South Carolina Assistive Technology Program Training Registration Form

South Carolina Assistive Technology Program
Training Registration Form