Greater Independence for Preschoolers to Insure Longterm Success As parents, we want all our children to grow up to be independent, responsible adults, including our children with special needs. How can we teach independence skills in ways that match our child’s developmental level, using everyday situations? How can we assist our preschoolers to think about the consequences of their behavior? Join us for a presentation with Dr. Tim Wahlberg, Psychologist, as he provides strategies to assist parents, and school staff, in navigating the challenge of developing independence in our preschoolers. Sponsored by: STAR NET Region II and Lombard School District 44 Tim Wahlberg, Ph.D. Presenter: Wednesday, November 9, 2016 Date: Lombard SD 44 Administration Building Location: 150 W Madison, Lombard, IL (Entrance on Green Valley Drive West)

Workshop Hours: 7:00-8:30pm Check-In: 6:30pm-7:00pm There is no cost to attend this event. Pre-registration is required. Families of children with IEPs or IFSPs, ages 0-5 years, may apply for a STAR NET Family Fellowship to offset travel and child care costs to attend this training. The Family Fellowship Application form is available at: http://www.thecenterweb.org/starnet/funding.html

 Fax this Registration to: 847-278-5434

OR Email to: [email protected] Mail to: STAR NET, 2626 S. Clearbrook Dr., Arlington Heights, IL 60005

OR

__________________________________________________________________________________________________________________________________________________________________________________________

PERSONAL INFORMATION

Circle Title: Dr.

Last Name

Ms.

Mrs.

First Name (Formal)

Mr. _____________________________________ Maiden Name (if applicable)

Middle Initial

Home Address

_____________________________________ State Zip Code

City ( ) Home Telephone Number

County

( )____________________________ Cell Phone Number _____________________________________

Last 4 Digits of Social Security Number

Preferred Email Address

EMPLOYMENT INFORMATION _________ School Name / District / Program Name

_____________________________________________________________________ Position

School / Work Address

City

_____________________________________________ State Zip Code

_________________________________(________)___________________________________________________________________________ County Work Phone Number OFFICE USE ONLY

Program Code:

Preferred mailing address: Home -or- Program/Work

Mail Status:

(please circle)

(11-9-16 Greater Independence 178803016 )

DUPLICATE AS NEEDED USE ONE REGISTRATION FORM PER PERSON AreRevised you the12/09 parent of a child with an IEP or IFSP? ___yes ___no

STARNet Greater Independence Registration.pdf

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