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Non-CPETracker Registration Form
Please complete a Non-CPETracker Form for each course or workshop you are planning to attend. There is a $20.00 fee (in addition to the registration fee) for each individual course or workshop if requesting CIU 20 to award Act 48 hours (excludes parents and individuals not requesting Act 48 hours).
To view our professional development offerings, please visit: www.ciu20.org/pd
Course or Workshop Title
List name of course or workshop
Your answer
Course / Workshop Instructor
List name of instructor
Your answer
Start date of above course or workshop
List specific start date
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Total dollar amount of registration fees for course or workshop listed
Be sure to include $20 additional fee if requesting Act 48 hours
Your answer
PPID#
Type "N/A" if you do not have a PPID number. To locate your Professional Personal ID, please go to: https://www.perms.ed.state.pa.us/ Screens/wfPublicAccess
Your answer
First Name
Your answer
Last Name
Your answer
Email Address
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Phone Number
Best number to reach you
Enter Phone Number
Please include area code
Your answer
Employer
Type "N/A" if Not Applicable
Your answer
Building
Type "N/A" if Not Applicable
Your answer
Grade Level / Content Area
Type "N/A" if Not Applicable
Your answer
Continuing Education Start Date: (Applicable to individuals with a PA Teaching Certificate)
To locate your Continuing Education Start Date please go to https://www.perms.ed.state.pa.us/ Screens/wfPublicAccess.aspx and enter your Professional Personal ID
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Payment Information
Checks are made payable to “CIU 20” and mailed to Colonial Intermediate Unit 20, Professional Learning, 6 Danforth Drive, Easton, PA 18045, Attn: Stephanie Agentis. Credit Card payments (3% fee) are also accepted. Please call Stephanie Agentis at 610-515-6424 to pay by credit card.
Purchase Order
Please list Purchase Order number below. Contact Stephanie Agentis if paying by Purchase Order - sagentis@ciu20.org, 610-515-6424
Your answer
Cancellation Policy
Please visit: www.ciu20.org/cancellation in order to review the CIU 20 Cancellation Policy and receive a full or partial refund.
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