MI Bridges Navigation Training Question Title * 1. Please complete the following registration information Name: Organization: Address: City/Town: ZIP: Email Address: Phone Number: Question Title * 2. Please Identify Collaborative Learning Opportunity You Are Registering For April 24, 2015 9:30 am – 12:30 pm Sanilac Career Center 175 East Aitken Road Peck, MI 48466 January 27, 2015 5:30 – 7:30 Saginaw YMCA 1915 Fordney Street Saginaw Mi 48601 Question Title * 3. Please identify your affiliation Young Adult/Individual with a Special Need/Disability Family Professional Both Family and Professional of a family member with a special need/disability Question Title * 4. If you are a professional will you be seeking CEUS? Yes No Question Title * 5. If seeking CEUS what type? SCECH Social Work Hours Both Question Title * 6. Do you need accommodations? Yes No Question Title * 7. If yes, what accommodations are needed? Mobility Visual Hearing Other Other (please specify) Next