HHSC

REGISTRATION FORM
Classroom-Based Cost Report Training
MEI - Mental Health (M), Early Childhood Intervention (E),
Individuals with Developmental Disabilities (I)

Return to the Rate Analysis Website


NOTE:   Must use Internet Explorer to complete
the registration form.
  • Submitting the below registration form does not complete your registration nor guarantee you a seat in the sessions you select.   Once your registration request has been processed, you will receive an e-mail with a confirmation number along with information about the training site for those sessions in which a seat has been reserved for you.  You should receive a reply within 5 business days.

  • You must register at least five business days prior to the training date.

  • There is limited seating for all sessions and registration is on a "first-come, first-served" basis.

  • Submit a separate registration form for each person attending the training.  Reservations will not be accepted by telephone, fax, or e-mail.

  • For questions/assistance with completing this registration form call (512) 730-7402, Monday thru Friday, between 8:30 am and 4:30 pm, Central Time.

Registration ID:
   First Four Letters of your Last Name

   (If your last name does not contain 4 letters, continue with letters from your first name. Example: Ron Lu would be LURO)

Last Four Digits of your Social Security Number:

 

Participants First Name:
   (as desired on training certificate)

 
Participants Last Name:
   (as desired on training certificate)

 

Mailing Address (street, P.O. Box):

City: State: Zip:

     

Daytime Phone Number:
   example: 512-438-5555

     

Fax Number:
   example: 512-438-5555

        

Email Address:
   example: Joe.Smith@myISD.edu

Re-Enter Email Address:

   

If you are willing to be contracted/hired by providers to prepare cost reports, place a checkmark in this box as authorization for HHSC Rate Analysis to give out your name to the public after you have successfully completed training.






MEI - Mental Health (M), Early Childhood Intervention (E), Individuals with Developmental Disabilities (I)

Due to seating limitations please only register for one class. 
If you register for more than one class we will only process the registration
for one class and the other registrations will be cancelled.


Date

City

Location

Room

Time

Seats

Session Number

Register

01/15/14 Austin JJ Pickle Research Campus 1.138 9:00 a.m. to 4:00 p.m.
Arrive by 8:45 a.m.
13-MEI-100
01/22/14 Austin JJ Pickle Research Campus 1.130 9:00 a.m. to 4:00 p.m.
Arrive by 8:45 a.m.
13-MEI-101
01/30/14 Austin JJ Pickle Research Campus 1.140 9:00 a.m. to 4:00 p.m.
Arrive by 8:45 a.m.
13-MEI-102
02/19/14 Austin JJ Pickle Research Campus 1.138 9:00 a.m. to 4:00 p.m.
Arrive by 8:45 a.m.
13-MEI-103
02/26/14 Austin JJ Pickle Research Campus 1.138 9:00 a.m. to 4:00 p.m.
Arrive by 8:45 a.m.
13-MEI-104
03/06/14 Austin JJ Pickle Research Campus 1.138 9:00 a.m. to 4:00 p.m.
Arrive by 8:45 a.m.
13-MEI-105


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