Please complete the information below. This will be sent by e-mail to your prospective mentor, so you can communicate with each other and determine a time to meet at Convention. If you do not hear from your mentor within two days, please contact him or her to discuss a meeting time and place.
First Name:
Last Name:
State:
University: Abilene Christian University Adelphi University Alfred University American International College Andrews University Appalachian State University Argosy University-Honolulu Argosy University-Phoenix Argosy University-Sarasota Arizona State University Arkansas State University Auburn University Azusa Pacific University Ball State University Barry University Baylor University Bowie State University Bowling Green State University Brigham Young University Bucknell University California State University-Chico California State University-Dominguez Hills California State University-East Bay California State University-Fresno California State University-Long Beach California State University-Los Angeles California State University-Northridge California State University-Sacramento California State University-San Bernardino California University of Pennsylvania Capella University Central Michigan University Central Washington University Chapman University-Orange Chicago School of Professional Psychology Cleveland State University College of New Rochelle College of Saint Rose College of William & Mary Columbia University Teachers College CUNY-Brooklyn College CUNY-Queens College Duquesne University East Carolina University East Central University Eastern Illinois University Eastern Kentucky University Eastern University Eastern Washington University Edinboro University of Pennsylvania Emporia State University Fairfield University Fairleigh Dickinson University-Teaneck Florida A&M University Florida International University Florida State University Fordham University Lincoln Center Fort Hays State University Francis Marion University Fresno Pacific University Gallaudet University George Fox University George Mason University Georgia Southern University Georgia State University Georgian Court University Governors State University Hofstra University Howard University Humboldt State University Idaho State University Illinois State University Immaculata University Indiana State University Indiana University of Pennsylvania Indiana University-Bloomington Interamerican University of Puerto Rico Iona College James Madison University John Carroll University Kean University Kent State University-Kent La Sierra University Lehigh University Lewis & Clark College Long Island University-Brooklyn Campus Long Island University-Westchester Graduate Campus Louisiana State University Louisiana State University-Shreveport Loyola Marymount University Loyola University Chicago Marist College Marshall University Graduate College Marywood College Massachusetts School of Professional Psychology McGill University Mercy College Miami University Michigan State University Middle Tennessee State University Millersville University Minnesota State University • Mankato Minnesota State University-Moorhead Minot State University Mississippi State University Montclair State College Mount Saint Vincent University National University-Fresno National University-Los Angeles National University-San Diego National-Louis University New Jersey City University New Mexico State University New York University Niagara University Nicholls State University Non Applicable North Carolina State University Northeastern University Northern Arizona University Northern Illinois University Nova Southeastern University Ohio State University Oklahoma State University Other Our Lady of Lake University Pace University Pennsylvania State University Philadelphia College of Osteopathic Medicine Plattsburgh State University Plymouth State University Radford University Rhode Island College Rider University Rivier College Roberts Wesleyan University Rochester Institute of Technology Rowan University Rutgers State University Sam Houston State University San Diego State University San Francisco State University Seattle University Seton Hall University Southern Connecticut State University Southern Illinois University-Edwardsville St. John's University Stephen F. Austin State University SUNY-Albany SUNY-Buffalo SUNY-Oswego SUNY-Plattsburgh Syracuse University Tarleton State University-Stephenville Temple University Tennessee State University Tennessee Technological University Texas A&M University Texas A&M University-Commerce Texas State University-San Marcos Texas Woman's University The Citadel Touro College Towson University Trinity University Tufts University Tulane University University of Alabama University of Alabama-Birmingham University of Arizona University of British Columbia University of Calgary University of California-Berkley University of California-Riverside University of California-Santa Barbara University of Central Arkansas University of Central Florida University of Central Oklahoma University of Cincinnati University of Colorado-Denver University of Connecticut University of Dayton University of Delaware University of Denver University of Detroit-Mercy University of Florida University of Georgia University of Hartford University of Houston University of Houston-Clear Lake University of Houston-Victoria University of Idaho University of Iowa University of Kansas University of Kentucky University of Louisiana-Monroe University of Maryland-College Park University of Massachusetts-Amherst University of Massachusetts-Boston University of Memphis University of Minnesota University of Missouri-Columbia University of Missouri-St. Louis University of Montana University of Nebraska-Kearney University of Nebraska-Lincoln University of Nebraska-Omaha University of Nevada-Las Vegas University of Nevada-Reno University of North Carolina-Chapel Hill University of North Texas University of Northern Colorado University of Northern Iowa University of Oregon University of Pennsylvania University of Rhode Island University of Saskatchewan University of South Carolina University of South Dakota University of South Florida University of Southern Maine University of Southern Mississippi University of Tennessee-Chattanooga University of Tennessee-Knoxville University of Texas-Austin University of Texas-Pan American University of Texas-Tyler University of the Pacific University of Toledo University of Toronto University of Utah University of Virginia University of Washington University of Wisconsin-Eau Claire University of Wisconsin-Lacrosse University of Wisconsin-Madison University of Wisconsin-Milwaukee University of Wisconsin-River Falls University of Wisconsin-Stout University of Wisconsin-Whitewater Utah State University Valdosta State University Valparaiso University Walden University Washington State University Wayne State University West Texas A&M University Western Carolina University Western Illinois University Western Kentucky University Wichita State University Widener University Winthrop University Worcester State College Yeshiva University-Bronx
Degree Program: Masters Specialist/CAGS Doctoral
Year in Program:
E-mail Address:
Phone Number (at which you can be reached during Convention):
Date of Arrival: Saturday 2/27 Sunday 2/28 Monday 3/1 Tuesday 3/2 Wednesday 3/3 Thursday 3/4 Friday 3/5 Saturday 3/6 Sunday 3/7
Date of Departure: Saturday 2/27 Sunday 2/28 Monday 3/1 Tuesday 3/2 Wednesday 3/3 Thursday 3/4 Friday 3/5 Saturday 3/6 Sunday 3/7
Primary Work Setting of Interest (please select one): High schoolMiddle schoolElementary schoolPreschool/Early ChildhoodPrivate schoolPrivate practiceHospital/clinicJuvenile justice systemAcademia
Primary Area of Interest (please select one): ABA/Autism/BCBAADHD/504/IEPCLD Intervention and AssessmentConsultationCounselingLocal/State/National LeadershipReading/Math/Writing DisabilitiesSevere DisabilitiesSocial-Emotional/Adaptive DisabilitiesTBIOther