Request enrollment

If a certificate of completion is provided for this course, we will use your name as it appears here when issuing your certificate.

1. First name (required):
2. Last name (required):
3. Email address (required):
4. Work phone (required):
5. Home phone:
6. School system:
7. School:

This information is required if you are registering for a course with a fee. Your enrollment will be rejected if you do not provide a complete mailing address.

1. Address:
2. Address (second line):
3. City:
4. State:
5. Zip Code:
6. Fee: $150
7. Payment Option Select payment option check purchase order credit card

Please provide the name and contact information of a central office curriculum specialist or personnel director who can verify your current employment with your school system. If you are not currently teaching in a North Carolina school system, this info is not required.

When you are accepted into the course, an email will be sent to your system contact to inform them of your participation.

1. Name:
2. Position:
3. Email Address:
4. Phone Number:

1. Do you agree with terms and conditions presented in the User Agreement? Yes No

1. Do you agree with terms and conditions presented in the Drop Policy? Yes No