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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).
NOTE: CPE CREDIT COURSE REGISTRANTS - Your registration status is "waitlisted" until the course registration fee is received. CPE Credit Course registration fees must be received prior to course start date.
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/wfProfessionalPersonnelID.aspx
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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