Supported Employment Training for Support Coordinators and Vocational Rehabilitation Counselors
APPLICATION
Full Name:
Address01:
Address02:
Address03:
City:

State:

Zip:

Telephone:

Fax:

Email:

 2. Please check the box which best describes you.
State Support Coordinator
Waiver Support Coordinator
VR Counselor
Other (Please specify)  
 3. Session(s)
AUG 17-18, 2004
Ft. Lauderdale
SEP 21-22, 2004
Ft. Myers, FL
SEP 28-29, 2004
Orlando, FL
OCT 20-21, 2004
Panama City, FL
OCT 27-28, 2004
Jacksonville, FL


Training sessions are limited to 30 participants