Session 3 ? Registration Form
 Download a PDF file of the registration form.

Please mail form along with check or purchase order to Laura Jarvis,
PBS 45 & 49, 1750 Campus Center Drive, Kent, OH 44240 by Jan. 26.

Name: ___________________________________________________________

E-mail: __________________________________________________________

District: __________________________ School: ________________________

School Address: __________________________________________________

City, State, Zip: __________________________________________________

School Phone: _________________________ Fax: _____________________

Home Address: __________________________________________________

City, State, Zip: __________________________________________________

Home Phone: ____________________________________________________

Additional information required if submitting payment for graduate credit:

Social Security Number: ______________________ Birthdate:___________

Are you a U.S. citizen? yes no

If no, provide your permanent resident # or visa type _______________

Provide name and location of college conferring your highest degree

__________________________________________ degree year ___________

(For online courses, make check or purchase order payable to PBS 45 & 49. Please send one payment per course.)

Optional University Credit

KSU credit (enclose an additional $250, made payable to Kent State University)

U of A credit (enclose an additional $290, made payable to The University of Akron)

Courses:

Update: Children?s Literature ? Online Resources (Children?s Authors on the Web: Online Sites That Motivate Students to Write, for Grades K-6)
Success With At-Risk Students: Differentiated Instruction (Creating Units to Support Differing Learning Styles)
Building Math Success for Students With Special Needs, Grade 4-8 (Enabling Students With Special Needs to Succeed in Math Class, Grades 4-8)
Desktop Publishing (Publishing on the Web)
Balanced Literacy: Reading in the Content Areas (Teaching Reading in the Content Areas)

Download a PDF file of the registration form.