WDLC Professional Learning Registration for Applying the Quality Matters K-12 Secondary Rubric April 15 to May 6, 2019
By completing and submitting the following information you are authorizing staff from organizations representing the Wisconsin Digital Learning Collaborative to create appropriate access, communications, and contacts for the desired professional learning opportunities as stated below. If you have questions please contact the Wisconsin Digital Learning Collaborative at wiwdlc@gmail.com

By submitting the following information you are validating that you have reviewed the syllabus and do want to proceed with the registration process. ALL fields must be completed for identification purposes or your registration will not be processed.

Last Name: *
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First Name: *
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Middle Name: *
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Mailing Address: *
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City: *
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State: *
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Zip Code: *
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Phone Number: *
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Date of Birth: *
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Email: *
Please use an email you will be checking regular and using for participation in this professional learning experience.
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Please list the school district, program, or organization with which you are associated.
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Professional Learning Cost, Credit, Privacy, and Signature
Please read the following and respond appropriately below.
Course Registration is NOT complete until payment is received. Please select payment option below. Note: As part of the WDLC partnership WVS/CESA 9 will be serving as the fiscal agent. The remaining cost of this professional learning experience is being subsidized by the Wisconsin Digital Learning Collaborative (WDLC). IF the participant does not successfully complete the course they may be billed an additional $200. Cancellations are accepted only by a signed fax or email and must be received by the stated cancellation deadline of one day (24 hours) prior to the course start date to dnordine@cesa9.org (715-891-1248 cell). Registration cancellations received on or after the course start date will not be eligible for a refund. *
Please provide the name, email, and phone number of the contact person who will provide payment for your enrollment. (Self pay or who will issue district purchase order etc.)
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FERPA Consent Form for Course Participation and Electronic Signature
Under the Federal Family Education Rights and Privacy Act of 1974 (FERPA) and Wisconsin State’s FERPA regulation, a student’s education records are protected from disclosure to third parties. Because of the public nature of wikis, blogs, google applications and other Web 2.0 applications students must provide written consent for participation in a course setting.

I understand that participation in a wiki, blog, google applications and /or other Web 2.0 applications are required for my successful enrollment in this professional learning course. By signing below, I give permission to further process my registration and communicate with me appropriately. I understand that some of the tools and applications used in this course may be open and accessible to the public.

I have agreed to submit this registration by electronic means. By signing this registration electronically, I certify under penalty of perjury and false swearing that the above information is accurate and complete to the best of my knowledge. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

Step 1. Check the box below *
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Step 2. Type in your name (First, Middle, Last) *
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Step 3. Type in today's date *
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