Illinois Experiential Practicum for Autism (IEPA) Registration
The Illinois Experiential Practicum for Autism is a five-day, hands-on training designed for school teams who want to strengthen their skills in supporting students with autism. Training Dates: July 13-17, 2026 @Stevenson Elementary School, Bloomington IL.
I am registering myself or a team:
*
Self
Team
Email address of person completing this form:
*
example@example.com
Back
Next
Coop
District
Participant 1 School
*
Participant 1 Name
*
First Name
Last Name
Participant 1 Email
*
example@example.com
Participant 1 Role
*
Please Select
Special Education Teacher
General Education Teacher
Paraprofessional
Speech Language Pathologist
Occupational Therapist
Program Administrator
Other:
Please specify Role if Other
Participant 2 School
*
Participant 2 Name
*
First Name
Last Name
Participant 2 Email
*
example@example.com
Participant 2 Role
*
Please Select
Special Education Teacher
General Education Teacher
Paraprofessional
Speech Language Pathologist
Occupational Therapist
Program Administrator
Other:
Please specify Role if Other
Participant 3 School
Participant 3 Name
First Name
Last Name
Participant 3 Email
example@example.com
Participant 3 Role
Please Select
Special Education Teacher
General Education Teacher
Paraprofessional
Speech Language Pathologist
Occupational Therapist
Program Administrator
Other:
Please specify Role if Other
Participant 4 School
Participant 4 Name
First Name
Last Name
Participant 4 Email
example@example.com
Participant 4 Role
Please Select
Special Education Teacher
General Education Teacher
Paraprofessional
Speech Language Pathologist
Occupational Therapist
Program Administrator
Other:
Please specify Role if Other
Participant 5 School
Participant 5 Name
First Name
Last Name
Participant 5 Email
example@example.com
Participant 5 Role
Please Select
Special Education Teacher
General Education Teacher
Paraprofessional
Speech Language Pathologist
Occupational Therapist
Program Administrator
Other:
Please specify Role if Other
Submit
Should be Empty: