Thom Academy Application FY 2027
Name:
*
First Name
Last Name
Email Address:
*
example@thomchild.org
Program:
*
Select your program
ASC
BMEI
CREI
MAEI
MVEI
FRAM
NVEI
PEI
SITS
WAEI
WITS
Discipline:
*
Select your professional discipline
Developmental Specialist
Occupational Therapist
Speech Language Pathologist
Physical Therapist
Social Worker
Nurse
Expressive Arts Therapist
Nutritionist
Counselor
Other
Thom Academy requires Program Director approval prior to application submission. Has your Program Director approved this application?
*
Yes
No
Enter the Name(s) of Training(s):
*
Enter the Date(s) of Training(s):
*
Training dates must occur between July 1st, 2026 & June 30th, 2027, to be considered.
How will this training benefit your work in early intervention and how will you share information learned with your early intervention program?
*
Total Cost of Training(s):
*
Employees will be reimbursed for value reflected in the receipt(s) submitted.
Amount Requested:
*
Maximum request is $300.00.
Submit
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