GRADUATE CREDIT REGISTRATION FORM
Educational Theory and Issues (ED 591G)
by Colorado State University
Please print all information.
Full Legal Name _______________________________
Social Security # ____________________Ethnic Origin ______
A = Asian
Highest Degree Attained___________________________
Gender: Female _______ Male _______
Birthdate (e.g., 12/31/52) ___________________________
Street Address _____________________________________________
City __________________________State_______ Zip __________
Home Phone _________________________ __
Office Telephone _______________________
check the 2-credit workshop (tuition at $85 per credit or $170 total)
in which you are enrolling:
_____ Assessment in Math and Science: What's the Point?
_____ Looking at Learning...Again, Part 1
_____ Looking at Learning...Again, Part 2
_____ Principles for Principals
_____ Teaching Reading 3-5
_____ Teaching Reading K-2
Please check the 3-credit course (tuition at $85 per credit or $255 total) in which you are enrolling:
(A separate form is required for each workshop or course.)
_____ The Learning Classroom
For which semester and year: _______________________________
Total tuition/fees enclosed ______________
_______ Enclosed is a check or money order (payable to Colorado State University).
_______ Please charge my MasterCard, VISA (circle one).
Credit Card #: _______________________Expiration Date: _____________
I certify that, to the best of my knowledge, the information furnished here is true and complete without intent of evasion or misrepresentation. I understand that if it is found to be otherwise, it is sufficient cause for rejection or dismissal.
Signature _______________________________ Date _________________
Mail or fax to:
Attn: Annenberg Media Workshops
Students wanting to withdraw from this workshop must do so in writing postmarked two weeks before the coursework deadline. In order to receive a refund (total tuition/fees minus a $25 processing fee), we need to receive a written withdrawal notice postmarked by the registration deadline. Changing the semester for which credit is received also carries a $25 processing fee, and must be requested prior to the last date of enrollment of the original semester for which you are registered. Please refer to Dates and Deadlines Table.