Application Form – ADI-R Online Clinical Training

Please select your course option: (required)
Option 1: Standard ADI-R training (2.5 days) for $ 1,125 CAD + taxesOption 2: Standard ADI-R training & Intro to use of the ADI-R for diagnostic differentiation – Case Discussion (3 days) for $ 1,295 CAD + taxes

Full name (as you would like it to appear on your certificate of completion) (required):

Email contact(required):

Primary phone number:

Mailing address:

Professional title and place of work (for professionals):

List any graduate degree(s) (for professionals):

List any membership to professional order(s) (Please no acronyms):

If in school, name the university AND program in which you are studying:

If in school provide the name of your graduate studies supervisor:

Expected date of graduation:

Briefly describe your training and/or experience working with individuals with Autism Spectrum Disorder:

How are you using the ADI-R in your professional practice?

How did you hear about us? (required)
Our websiteColleagues/FriendsOntario psychologySchoolOther