2017-2021 Open Science Nights - Teacher Registration for CTLE Credit
PLEASE NOTE - IF YOU DO NOT COMPLETE THIS FORM ACCURATELY AND COMPLETELY - AND SIGN THE ATTENDANCE SHEET EACH DAY OF THE EVENT, YOU WILL NOT RECEIVE A CERTIFICATE FOR CTLE ATTENDANCE.

YOU MUST REGISTER FOR CTLE CREDIT HERE WITHIN ONE WEEK OF THE EVENT.
Email *
Date of Open Night attended. Please enter using this format: mm/dd/yyyy *
Last Name *
First Name *
Birthdate (mm/dd/yyyy) *
Last four digits of Social Security # *
Street Address *
City *
State *
Zip Code *
A copy of your responses will be emailed to the address you provided.
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