center 300 N. Fifth Ave., Suite 21 Ann Arbor, MI

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1 AUTISM DIAGNOSTIC INTERVIEW REVISED (ADI-R) Introductory Clinical Workshop Application Dates Monday, November 14 and Tuesday, November 15, 2016 (Monday 8:00AM-4:30PM & Tuesday 8:00AM 4:30PM) Thank you for your interest in the Autism Diagnostic Interview-Revised (ADI-R): Introductory Clinical Workshop that Sunfield Center is offering in collaboration with the University of Michigan School of Kinesiology! This training is designed for clinicians with a prior background in autism, clinical interviewing and assessment of individuals with ASD. Psychologists, physicians, speech-language pathologists, social workers as well as professionals and graduate students in related fields are welcome to apply. Those who intend to use the ADI-R in research, must attend the ADI-R Research Training and establish research reliability with a designated research group. During this two-day workshop, trainers will provide an overview of ASD including the importance of early diagnosis and treatment and best practices for diagnosing ASD. Additionally, trainers will present on the clinical use of the ADI-R including a review of administration and scoring procedures. The ADI-R (authored by Michael Rutter, Anne Le Couteur, and Catherine Lord) is a comprehensive interview that provides a thorough assessment of individuals suspected of having an autism spectrum disorder. The interview questions, which are administered to caregivers, cover several content areas including early development, language acquisition/possible loss of language or other skills, current functioning in regard to language and communication, social development and play, as well as restricted interests and repetitive behaviors. The ADI-R in conjunction with the Autism Diagnostic Observation Schedule-2 nd Edition (ADOS-2) has proven very effective in diagnosing autism spectrum disorders in individuals suspected of having autism. Independent trainers will be providing the workshop through a variety of teaching methods, including lectures, videos, coding discussions and administration of the instrument. Sunfield Center is approved by the American Psychological Association to sponsor continuing education for psychologists. Sunfield Center maintains responsibility for this program and its content. Sunfield Center designates the 14 CE credits for the ADI-R trainings. Location The University of Michigan Ann Arbor, MI Fees Complete applications postmarked on or prior to Friday, September 9 will qualify for the early bird registration fee of $650. The registration fee for applications postmarked on or after Saturday, September 10 is $700. All training fees are subject to change without notice. Payment and Refund Policy We accept payment in the form of a check made payable to Sunfield Center. We also accept payment via credit card (please see attached credit card form). Please do not send purchase orders. Payment is due with the application. Please note that there will be no refund once payment is processed. Pre-course Information Once your application has been received you will be ed a pre-course packet and confirmation of your enrollment in the workshop. The confirmation will be sent approximately three weeks prior to the training date. Information about the schedule and location will be included in this packet. Carefully review this application, purchase the required materials (see below) including the ADI-R manual. Read the ADI-R manual and all pre-course materials prior to the workshop and please come prepared. We have included information regarding accommodations, as you may need to make hotel reservations prior to receiving your confirmation . Please note that enrollment is subject to space availability. Completing the application does not guarantee admission.

2 Required Materials Participants are required to bring the following to the workshop: 1. A copy of the ADI-R manual (WPS item #: W-382B) 2. Three Interview booklets (WPS item #: W-382A) 3. Three comprehensive algorithm forms (WPS item #: W-382E) Sunfield Center cannot provide these materials; these can be purchased directly from Western Psychological Services (WPS) or by phone at (800) Please contact WPS to obtain these materials as soon as possible in order to have them on time for the workshop. For additional questions, please us at training@sunfieldcenter.com or call us at (734) Please note that enrollment is subject to space availability. Completing an application does not guarantee admission. Please submit the following application with a copy of your CV/resume and payment as soon as possible. Note that Sunfield Center reserves the right to make decisions regarding whether an individual or a site is appropriately suited to make the best use of this training. 2

3 UNDERSTANDING AUTISM SPECTRUM DISORDERS (ASD) & THE CLINICAL USE OF THE AUTISM DIAGNOSTIC INTERVIEW REVISED (ADI-R) Introductory Clinical Workshop Application Name: Degree: Title: Department: Institution: Contact Information: Business Phone: Home Phone: Cell Phone: Address: Secondary Work Address Street: City: State & Postal Code: Country: Once accepted into the workshop, you will be notified via . You will also be ed pre-course information. Please write below your preferred address for this correspondence (double check your address to ensure there are no errors). Prior to mailing your application please make sure that you have completed the following steps: Completed and printed this application form. Included a copy of your CV/resume. Attached the credit card authorization form / OR Enclosed a check made payable to Sunfield Center. Early Bird Registration Fee (payment postmarked on or prior to 9/9/2016): $650 (check payment) Regular Registration Fee (payment postmarked on or after 9/10/2016): $700 (check payment) Sunfield Center Attention: November Clinical ADI-R Training 300 N. Fifth Avenue, Suite 210 Ann Arbor, MI MAIL YOUR COMPLETE APPLICATION TO: 3

4 Accommodations Other hotel options near the training location: Stone Chalet Bed & Breakfast (special rate) Phone Number Address/Zip 1917 Washtenaw, Distance 2.5 mi Price $$$ ** Ann Arbor Bed & Breakfast E. Huron, walking $$$ ** Bell Tower Hotel S. Thayer, walking $$$ ** Inn at the Michigan League N. University, walking $$$ ** The Dahlmann Campus Inn E. Huron St, walking $$$ Hampton Inn Ann Arbor North Green Rd., mi $$$ Holiday Inn Express Ann Arbor Briarwood Cir, mi $$$ Kensington Court Ann Arbor Hilton Blvd., mi $$$ Ann Arbor Regent Carpenter Rd., mi $$$ Courtyard by Marriott Boardwalk, mi $$$ Red Roof Inn S. State St., mi $$ Hampton Inn Ann Arbor South Victors Way, mi $$ ***Holiday Inn Plymouth Rd., mi $$ ** Within walking distance. Some hotels listed above may offer a free shuttle service, so check with your specific hotel for more information. Average cab fare fro hotels is generally less than $10, but please be aware that cabs may not reliably arrive on time to your hotel. For your convenience, we recommend that you stay within walking distance. Transportation Shuttle Services To and From Detroit Metro Airport AA Airport Shuttle: Metro Cars: $32-$37 one-way / $62 round trip $59 one way Custom Transit: Metro Taxi: $68 round trip $45-$50 one way Taxi Services Ann Arbor Taxi Services: Blue Cab: Yellow Cab: Fees To and From Detroit Metro Airport: - $50 from Central Campus, for up to four people. - $60-$61 (metered) one-way to airport plus airport fees. Public Transportation Ann Arbor has a bus system that runs to most places around Ann Arbor and Ypsilanti. For bus stop locations and bus routes, you may wish to consult There is a flat rate of $1.50. Car Rental For information about the different car rental companies available from Detroit Metro Airport, you may wish to look at 4

5 CREDIT CARD AUTHORIZATION For your convenience, please complete this form that authorizes us to charge your credit card for each transaction without you being present to sign. A receipt will be provided via when payment is made by credit card. We also accept cash and check payments. Name on Credit Card: Address: Phone number: Training Participant Name and type of training: Early Bird Registration Fee (when payment is postmarked on or prior to Friday, September 9 th 2016): - Understanding ASD & the Clinical use of the ADI-R: $650 (check payment) Regular Registration Fee (when payment is postmarked on or after Saturday, September 10 st, 2016): - Understanding ASD & the Clinical use of the ADI-R: $700 (check payment) PLEASE NOTE THAT A $25 CONVENIENCE FEE FOR CREDIT CARD PAYMENT WILL BE ADDED SEPARATELY TO EACH WORKSHOP PAYMENT. REFUND AND CANCELLATION POLICY: Please note that there will be no refund once payment is processed. Please check one:! American Express! Mastercard! Visa I,, authorize Sunfield Center to charge my credit card number, expiration date, security code and billing zip code. Please provide your below if you would like to receive an electronic receipt of payments. Print Name Signature Date 5