Teachers as Scholars Registration Form

This application should only be filled out by teachers who have been approved to attend Teachers as Scholars and/or Administrators as Scholars by their school or school district representative.

Fields marked with * are required.
The Online Registration Form deadline for Teacher as Scholars AND Administrators as Scholars is December 14, 2020.

Seminar dates and descriptions are provided here.

Seminar Information

Seminar Name *

Approval from the School *

Received approval for the selected seminar from your school

Yes

N/A

Approval Status

If applicable, please list if you are an additional or alternate attendee for the selected seminar:

Alternate Attendee

Additional Attendee

Your Personal Information

Name *

First Name

Last Name

Primary E-mail *

Seminar logistics and reading materials will be sent to the address provided

Phone *

In case of emergency or changes, this phone number will be contacted

Address 1 *

Seminar logistics and reading materials will be sent to the address provided

Address 2

City *

State *

ZIP Code *

Dietary Restrictions *

Vegetarian

Gluten-free

None

Other

Other food restriction(s)/allergy not listed

School District Information

School District *

Other

Please write the name of your school district if not represented in the options above

Address 1

Please list the address for school.

Address 2

City

State

ZIP Code

Grade Level *

Content Area *

Additional Comments

Please leave any additional comments or information here.

Comments

Leave this field blank