Course Registration

Please complete all of the items below and then click the "Submit" button. To register for this course, you will be getting an email sent to your home email address in order for it to be activated.

Create a password: (must be 7 - 15 characters)
First Name:
Last Name:
Address:
(line 2 optional):
City:
State:
Zip:
Home Phone:
Home Email: (Used for logging in)

Work Classification:
Work District:
Work Email:
Current Position:
If applicable, grade(s) you are teaching:	N/A

Certified in ESE:	Yes No
Exceptionalities:
Certified in Basic Education:	Yes No
Are you teaching In or Out of Field?	In Out
What teaching certificates do you currently hold?

I plan to take the Elementary K-6 Certification Exam: Fall (Sept., Oct., Nov.) Winter (Dec., Jan., Feb.) Spring ( March, April, May) Summer (June, July, Aug.) N/A - (Administrator accessing module for technical assistance purposes only.)
Please describe your previous online learning experience.