UCSB KOEGEL AUTISM RESEARCH & TRAINING CENTER
      ED 199RA Recruitment Form
      Phelps 1157
      (805) 893-2049
      autism@education.ucsb.edu

      Date:

      Name:

      Address:

      City:

      Phone:

      Email:

      Major:

      GPA:

      Related Experience:



      Times Available:

      Check if:
      ___Access to a car
      ___Available two quarters
      ___Willing to work occasional weekends
      ___Available to work during the summer
      ___Multilingual (What languages?) _________________________
      ___Interested in Research Experience
      ___Interested in Clinical Experience
      ___Interested in being included on the respite/caregiving list distributed to families

      For more information, please contact us at autism@education.ucsb.edu