31stAnnualSPINConference
Datereceived:______________________________
SPIN C onference
April22,20178:30am–3:30pm
UHCampusCenter,3rdFloorBallroom,Honolulu,HI
Pleaseprintclearly
Name________________________________________________________________________________________
Address_____________________________________________________________________________________
City_____________________________________________Zip_________________Island______________
Phone(H)__________________________(C)_________________________(W)_____________________
E-mail_______________________________________________________________________________________
Child’sDisability___________________________________________________Child’sAge__________
Child’sSchool_______________________________________________________________________________
PleaseregistermefortheSPINConference
r$25perParent,r$45fortwoFamilyMembers,r$25perCollegeStudent,r$40perProfessional
❐ Amountenclosed$__________________check#___________________Rcvdby_______________
MakecheckspayabletoSPIN(SpecialParentInformationNetwork)
*AirfareScholarshipsarelimited,andbasedonavailability~applyearly!*
❐ IamaNeighborIslandParent/Grandparentofachildwithspecialneedsandwouldliketoapplyfor
aSPINAirfareScholarship.(max.2scholarshipsperchild)
❐ Pleasesendmeanapplicationvia❐ email❐ postalmail
❐ MyAirfareScholarshipapplicationisenclosed
❐ Iwillsendintheapplicationlater
*RequestsforaccommodationsmustbesubmittedbyMarch15,2017*
❐Ineedanaccommodationduetoadisability
❐ Materialsinanalternateformat(Braille,tape,etc.)Type:_________________________
❐SignlanguageinterpreterorCARTType:_________________________________________
❐Other:__________________________________________________________________________________
❐ SignmeupforSPINE-Newsletter❐ SignmeupforE-Blastsofworkshopsandevents
Amapoftheconferencecenterandamapofparking,includingaccessibleparkingstallsforpersonswith
disabilities,willbesentoutafewweeksbeforetheconferenceviaemail.
Pleasecheckhere❐ ifyoupreferthisinformationbesentviapostalmail.
Sendcompletedform(s)withpaymentassoonaspossibleto:
SPIN,919AlaMoanaBlvd,Room101,Honolulu,Hawaii96814
Fax:(808)586-8129
E-mail:[email protected]
Questions?Callus(808)586-8126
Web:www.spinhawaii.org
Databaseentered:____________________________Emailentered:________________________________Emailconfirmationsent:_______________________________
Booked:___________________Confirmation#:_______________________________________datereceived:____________________
“SUPER H ER OES of SPIN ”
2017SPINCONFERENCE
UniversityofHawaiiCampusCenter
April22,20178:30am–3:30pm
AIRFARESCHOLARSHIPFORM
Name:___________________________________________________________________________________________________
*NOTE:MakesurenamewrittenaboveisyourlegalnameasitappearsonyourI.D.
Address:_________________________________________________________________________________________________
StreetorPOBox
City ZipCode
Contact:____________________________________________________________________________________________
HomePhone CellPhone Email(forflightconfirmation)
DateofBirth:____________________________________Island:______________________Ageofchild:________
(TSArequirementforbookingflights):
❒ Hawaiian Airlines
❒ Island Air
(childmustbereceivingspecialeducation
orEarlyInterventionservices)
❒ Mokulele Airlines
❒ Ohana,
First Choice:
Departure Date: ___________________ Time: __________________ Flight #___________
Return
Date: ___________________ Time: __________________ Flight #___________
SecondChoice:
Departure Date: ___________________ Time: __________________ Flight #___________
Return
Date: ___________________ Time: __________________ Flight #___________
Checkallthatapply.
❒ IacceptthetermsoftheTravelGuidelines(seeattached)
*Thisboxmustbecheckedbeforetravelisarranged*
❒
I would like to sign up for the airport shuttle service to and from the SPIN Conference.
❒
I have enclosed my Registration Form & fee in the amount of $________________
($25 parent, $45 for 2 family members, $25 College Student, $40 professional)
Make checks payable to SPIN – Special Parent Information Network
Office only: Received check on ______________________ check #__________________ $_____________
Database input: ______________ Email input: ________________ Confirmation email sent:____________________
PLEASE COMPLETE AND SEND BACK TO SPIN
Fax: (808) 586-8129 E-mail: [email protected]
919 Ala Moana Boulevard, Room 101, Honolulu, HI 96814
Booked:___________________Confirmation#:_______________________________________datereceived:____________________
TRAVEL GUIDELINES
Our SPIN A dvisory Committee has determined that all our airfare recipients must follow these
guidelines so that SPIN can be both efficient and fair in our travel support to families.
Ø Air far e Scholar ships ar e limited to two adult family member s per child with special
needs.
Ø Scholar ships ar e pr ovided to parents of infants, toddlers and school-aged children with
disabilities. The child must be under 22 and cur r ently r eceiving ear ly inter vention or
special education and r elated ser vices.
Ø Scholar ships ar e limited and pr ovided on a fir st-come, fir st-ser ved basis. They ar e
distr ibuted evenly by island and age of student. Scholar ships ar e not guar anteed until
confir med by SPIN.
Ø Recipients will need to fill out state-r equir ed paper wor k.
Ø Confer ence r egistr ation for m and fees should accompany your completed Air far e
Scholar ship For m. Flights will not be booked until registration form and fees have been
received. If your r egistr ation fees ar e being paid for by another agency or or ganization,
please indicate that on the r egistr ation for m.
Ø If a flight change/cancellation must be made, call the SPIN office (808) 586-8126, and not
the air car r ier . Some flights will be made by a sponsor or ganization. You will be given
dir ections on what to do in case of a flight change or cancellation with them.
Ø We discour age making changes after r eser vations ar e made, please make sur e your dates
ar e fir m. If a change is r equir ed, it must be ar r anged thr ough SPIN. Any flight change
fees ar e the r esponsibility of the tr aveler .
Ø You should call the air car r ier dir ectly ONLY if you have an emer gency on Fr iday
after noon (the day befor e the confer ence) or on the mor ning of the confer ence that
pr events you fr om attending the confer ence.
o Hawaiian Airlines Reservations: 1-800-367-5320
o Mokulele Air Reservations: 1-866-260-7070
o Cancel your own flight arrangements at least 90 minutes prior to departure time.
o Make sure to leave a message on the SPIN line (808-586-8126) notifying us of your
cancellation/emergency.
Ø Shuttle Service: Complimentar y shuttles ar e being ar r anged on the day of the confer ence
to and fr om the Honolulu Inter national Air por t and the confer ence site at UH Manoa.
Ø The Air far e Scholar ship pr ogr am cover s air far e only and does not include
tr anspor tation costs, i.e.: mileage, par king fees, taxi or bus far e, or ar r angements to
and/or fr om the air por t on your home island or on Oahu.
Ø Once you ar e notified of a scholar ship awar d, you will have 5 days to confir m your
par ticipation and pr ovide all the infor mation we need to ar r ange tr avel. If we do not
hear back fr om you within 5 days, your awar d will be given to the next per son on the list.
Ø Failur e to follow these Tr avel Guidelines may r esult in a loss of cur r ent and futur e
scholar ships.
2017 SPIN AWARDS
Nomination Form
Every year, SPIN publicly acknowledges key parents and professionals whose efforts
make a positive difference in the lives of children and young adults with disabilities and their
families in Hawaii. We are asking for your help in identifying candidates for SPIN's major
awards: Parent of the Year, Professional of the Year, and the Family Choice Award. Please
offer your suggestions for these three awards below and return this form or call SPIN with
your nominations by March 25, 2017. If you have more than one nomination per category,
feel free to copy this form and submit multiple nominations. Should you have any
questions, please call Susan or Amanda at the numbers below.
Address: SPIN, 919 Ala Moana Blvd., Room 101, Honolulu, HI 96814
Phone: (808) 586-8126
Fax:
(808) 586-8129
E-mail: [email protected]
Parent of the Year Award
The Parent of the Year Award is given to a parent of a child or young adult with a
disability whose actions and advocacy have benefited other families. Past winners have
included, Debbie Kobayakawa, Rosie Rowe, Brendelyn Ancheta, Barbara Ioli, Jo Ann Ahuna,
Susan Wood, Noe Dela Vega, Barbara Poole-Street, Lyna Burian, Ginny Wright, Donna
Makaiwi, Catha Combs, Amanda Kaahanui, Kim Rivera, Sue Emley and Kiele Pennington.
Nominee's Name
Nominee's Community or Workplace
Your Name
__Phone
Reason for nomination:
Phone
E-mail__________________
Professional of the Year Award
The Professional of the Year Award is given to a professional who has had a significant
impact in improving services for children or young adults with a disability and their families.
Past winners have included Representative Roy Takumi, Bill Arakaki, Sue Brown, Lolly
Romano, Jean Johnson, Gloria Kishi, Steve Hanai,
Professional of the Year Award (cont.)
Colleen Casey, Rhonda Black, Bess Tanabe, Mike Tamanaha, Melanie Garde, Dr. Bill Bolman,
Lesley Alexander, Joanne Morisato, Patricia Sheehey and Dr. Dan Ulrich.
Nominee's Name
Nominee's Community or Workplace
Your Name
__Phone
Reason for nomination:
Phone
E-mail__________________
Family Choice Award
The Family Choice Award is given to a professional who has been particularly helpful to
families as they sort out services for their child with a disability. This individual may not have
an impact on the larger system, but is recognized in his or her community as an extraordinary
professional. Past winners have included Tammy Evrard, Susan Okamura, Nanette Sauceda,
Evan Matsuhima and Suzie Ota, Artice Swingle and Lane Yanagisawa, Ana Gamble, El Doi,
Jessica Wong-Sumida, Alice Bratton, Patricia Tholen and Shrene Naki.
Nominee's Name
Nominee's Community or Workplace
Your Name
__Phone
Reason for nomination:
Mahalo for your nominations!
Phone
E-mail__________________