Self Determination Training Registration : Self Determination : Programs : What We Do : Club 21 Learning and Resource Center

Dates: Thursday Nights 6:00-8:00pm(Meets over Zoom)

September 4, September 18, October 2, and October 16

We will offer three optional check in/QA dates: Dates TBD for person centered planning and spending plan hands on work.

If you have any questions, please email programs@clubtwentyone.org.

Apply for a scholarship HERE.

First Name

Last Name

Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

E-mail

Phone

Child Name

Child's Birthdate

Month

Day

Year

Child's Grade

What is Your Child's School Setting:

Homeschooled
General Education
Special Education
Day program
Other

Club 21 Member?

This training is a perk of Club 21 Membership. Please confirm your membership.

Please select your payment option below.

Payment in full $200
$50 down payment + $50 next 3 month (be sure to select monthly payment in the credit card information section below)
I will be applying for a scholarship or using SDP Funds to pay (which is a separate application)

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Financial Management Services Name (FMS)

Service Code:

Child's UCI#

Credit Card Information

Cardholder Name

Credit Card #

Expiration Date

Security Code

Make this a monthly payment?

Yes, charge me today and on the 3rd of every following month.

Make this a monthly payment?

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged

Self Determination Registration

Self Determination Training Registration

Dates: Thursday Nights 6:00-8:00pm(Meets over Zoom)

September 4, September 18, October 2, and October 16

We will offer three optional check in/QA dates: Dates TBD for person centered planning and spending plan hands on work.

Credit Card Information

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