UW LEND Alumni Update Form Test – Clinical Training Unit

Thank you for interest in the UW LEND Alumni Directory. Please complete this form to join the directory or to update your existing information. Only fields with an (*) are required. Please provide responses that are the best fit for you.

First Name*:	Last Name*:
Preferred email*:	LEND Discipline*:
Professional Degree:
------------------------------------------- Share information about your clinic or community agency as it relates to serving individuals and families in the developmental disability community. Note: If you don’t have a clinic or community agency to specify, please provide just your location information.
Name of Clinic or Agency:	City*:
County*:	State/Province*:
Clinic/Agency Website:	Languages spoken:
In a few words describe area of service (for example diagnosis, age range, type of service):