Teaching Educational Autism Methods (TEAM) Interest Name* First Last Email* Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo Congo, Democratic Republic of the Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czechia Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russian Federation Rwanda Réunion Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Sweden Switzerland Syria Arab Republic Taiwan Tajikistan Tanzania, the United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkmenistan Turks and Caicos Islands Tuvalu Türkiye US Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Country Phone* Semester Requested*Spring 2025 Summer 2025 Fall 2025 Spring 2026 Summer 2026 Fall 2026 Position of Interest*University Practicum Placement Professional Observership Internship Experience Observation Hours Supervised Hours For students interested in practicum placement, what number practicum placement is this?*1st Practicum 2nd Practicum 3rd Practicum 4th Practicum 5th Practicum 6th Practicum 7th Practicum 8th Practicum Other Please indicate the practicum for which you are applying:*Basic Intermediate Advanced I Advanced II BSW Foundation MSW Foundation MSW Concentration Other If you selected other to the question above, please type practicum here:* Are you currently studying any of the following? Applied Behavioral Analysis (ABA) Speech & Language Pathology Social Work Sports and Recreation General Autism Internship Experience (non-specific to a discipline) Marketing and Development Professional Observership Program (Fee-based program) Other Expected graduation date: MM slash DD slash YYYY Degree of diploma: Previous Work Experience List all clinical related work experience (include company/organization name and job title/description):* How many documented clinical hours do you expect to have when you begin this practicum experience?* How many documented clinical hours have you had specific to Autism Spectrum Disorder?* How many documented clinical hours have you had specific to pediatrics in the field of ASD?* How many documented clinical hours have you had specific to adults with ASD?* Upload Cover Letter and CV/Resume* Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB, Max. files: 4. Please provide supporting documentation with your application.