Course Registration

WorkWorks will accept applications until the course is filled. Persons applying after the class is full will be placed on a waiting list for the next available slot. To ensure your acceptance, it is important that our office receives your application and the tuition fee. We will accept your personal check or a purchase order from your sponsoring organization. As soon as both are received, we will notify you of your acceptance.

Several options are available to you to register for this course. Click Register for Employment Services Specialist Training above and submit the completed form via the web or download and mail the completed form to WorkWorks.

Contact

Phil Chase
pchase@uga.edu
706-542-1360

Register

Complete the online registration form below
Letter: WorkWorks, IHDD, 850 College Station Road, Athens, GA 30602-4806;
Fax: 706-542-4815
Phone: 706-542-1360, but written confirmation must follow

Tuition

$1000.00 per student - includes technical assistance, course materials and instruction.

Checks should be made payable to the Institute on Human Development and Disability. Full tuition is due at the time of registration and tuition amount is subject to change.

Cancellation Policy

Before a program begins, the Institute incurs substantial costs related to individual registrations. Therefore, registrations cancelled less than four weeks prior to the starting date of the program will incur a charge of 25 percent of the full program fee; within five days of the program, 75 percent will be forfeited. For the convenience of an agency, substitutions may be made at no cost. Participants who substitute must have an approved application.

Class size is limited

It is important to register as far in advance as possible.

Personal Information

First Name

Last Name

Name as you want it to appear on the Certificate of Achievement

Street Address

City

State

Zip Code

Phone Number

Format: 000-000-0000

Cell Phone

Job Title

Your Education Level

Date of Birth (mm/dd/yyyy)

Organization Information

Organization

Organization Address

Organization City

Organization State

Organization Zip Code

Organization Work Phone

Organization Fax

Organization Website

Supervisor's Name (if sponsored)

Supervisor's Email (if sponsored)

Additional Information

Credits

I want Continuing Education Units (CEU’s)

I want Continuing Maintenance for CRC (CM-CRC)

Note: must be a Certified Rehabilitation Counselor to receive CM-CRC)

Certified Rehabilitation Counselor Number (CRC#)

My Experience Working With People With Disabilities Includes

I Want To Participate In The Employment Specialist/Job Coach Program Because

My Computer Skills Are

Accomodations Needed

If the requested session is full, I would like to be placed on a waiting list for the next available course YesNo

Tuition My personal check/money order for my full tuition is in the mail.My organization’s check for my full tuition is in the mail.My organization’s purchase order for my full tuition is in the mail. Please send an invoice.I would like to develop a payment plan – please explain my options.

Send Questions To

Philip E. Chase, Director

WorkWorks

Institute on Human Development and Disability

The University of Georgia

850 College Station Road

Athens, GA 30602