ATC Registration for Services Form

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Confidentiality Notice

Please keep in mind that even though submission of this form is TLS-encrypted, the information you provide is not stored by a HIPAA-compliant service. While we take appropriate measures to only allow authorized individuals to access your application and submitted documents, there is an unlikely possibility that information you include on this form can be read by other parties besides the Autism Training Center.

Time Limit Notice

This application must be completed within 45 minutes.

A timer at the upper right-hand corner will display the amount of time left to complete, and a reminder will display at 2 minutes. If not completed within the time limit, you will need to start another application. We apologize for the inconvenience. If you are unable to complete the electronic application within the time limit, you may download a paper application at:

Registration for Services PDF

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