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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) |
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| Last Name:
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| First Name:
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| Address:
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| (line 2 optional):
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| City:
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| State:
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| Zip:
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| Home Phone:
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Home Email:
(Used for logging in)
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| Work Address:
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| (line 2 optional):
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| City:
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| State:
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| Zip:
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| Work Phone:
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| Work Email:
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| District:
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Place of
Employment: |
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| Current Position:
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If applicable, grade(s)
you are teaching: |
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| ESE Certified:
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| Areas of Certification:
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Are you teaching In
or Out of Field? |
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What teaching
certificates do you currently hold?
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I plan to take the ESE K-12 Certification Exam:
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Please describe
your previous online learning experience.
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