SOS Mentorship – Registration - SOS Approach to Feeding

Please select from the following SOS Mentorship Sessions*

May 12-July 28, 2021: Extended
September 13-November 22, 2021: Standard
COURSE SOLD OUT - January 25-April 12, 2021:Standard

Contact Information

Name

First Last

Job Title

Discipline*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Email*

Continuing Education Information

Toomey & Associates is an approved continuing education provider for CDR, AOTA and ASHA.

Will you be requesting CEUs for ASHA?*

Yes
No

For ASHA, please provide your ASHA ID

ASHA requires additional information when requesting CEUs.
(CDR and AOTA does not require this additional information.)

Prerequisite Requirements

Completion of the Basic SOS Approach to Feeding Course (3.75 Day) after 2015,OR completion of the Basic SOS Approach To Feeding Course (2.5-3 Day) PLUS the Advanced Topic Course (Online or In Person) = “Tools in Your Pantry: Effectively Using the New Oral Motor Steps”.

SOS Basic Conference Details

Completion Date*

Please select the date that you completed the SOS Basic Conference (last day of the conference).

City and Country of Conference Attended*

SOS Certificate of Attendance*

Please upload your SOS Certificate of Attendance. (If you do not have a copy of your certificate of attendance, please request a copy from the host where you attended the conference.) File Size Limit - 50MB

Advanced Workshops

SOS Advanced Workshops

Please select all of the SOS Advanced Workshops that you have completed.

SOS Advanced Workshop - #1 Certificate Upload

Please upload your certificate(s) of completion for SOS Advanced Workshops. File Size Limit - 50MB

SOS Advanced Workshop - #2 Certificate Upload

Please upload your certificate(s) of completion for SOS Advanced Workshops. File Size Limit - 50MB

By checking the box, I have read and understand the course requirements and expectations of participants.*

I agee

Personal Photo*

Please upload a personal photo. This photo will be used on the learning platform during the course sessions. File Size Limit - 50MB

Professional Experience & Focus

Primary Work Setting*

What is the primary population of your feeding therapy services?*

Autism Spectrum Disorders
Visually Impaired
Children w/ multiple medical complications
Developmental delays
Neurological/motor impairments
Picky/restricted/selective/fussy eaters
Sensory Processing Disorders
School-aged children
Other

How many years of pediatric work experience do you have?*

How many years of feeding therapy experience do you have?*

What percentage of your caseload is Feeding Clients?*

0%-25%
25%-50%
50%-75%
75%-100%

At what level do you implement the SOS philosophy?*

Fully implement
Implemented fully to best of my ability-modifications due to site's physical constraints
Use of some SOS combined w/different approaches

How many years have you been implementing the SOS philosophies into your practice?*

Cancellation Policy

The tuition, less the $50 registration fee, will be refunded if SOS Approach to Feeding receives written notice of cancellation from the registrant at least 15 business days prior to the scheduled start date of the program. The full tuition will be charged to registrant who cancel 14 or fewer business days before the schedule start dated to the program or registrants who fail to attend the first scheduled course.

By checking the box, I have read and understand the cancellation policy.*

I agree

SOS Mentorship-Standard

Course total: $650.00 (U.S.) 50% of the course tuition due upon registration. Balance due one month prior to the completion of the course.

Price: $325.00

SOS Mentorship-Extended

Course total: $720.00 (U.S.) 50% of the course tuition due upon registration. Balance due one month prior to the completion of the course.

Price: $360.00

Coupon

SOS Mentorship - Down Payment

$0.00

Amount to be charged now. Balance to be invoice one month prior to the completion of the course.

Credit Card

Card Details

Cardholder Name

Comments

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