Registration Form--TSI Professional Development Program
REGISTRATION AND CONFIRMATION
After completing and submitting the registration form, watch for the REGISTRATION CONFIRMATION screen to appear after you hit the SUBMIT button. You must be registered in order to receive professional development hours. Thank you!
LAST NAME
Your answer
FIRST NAME
Your answer
Name of college/university or program where employed:
Your answer
EMAIL
(please list the address you check regularly)
Your answer
Years employed at current college/university or program:
Year
Years
If more than 10 years please indicate number of years employed at current college/university or program:
(Answer only if more than 10 years)
Your answer
Years of teaching experience:
If more than 10 years please enter total number of years of teaching experience:
(Answer only if more than 10 years)
Your answer
Course load per semester (number of semester hours):
Your answer
Which of the following best describes your current role:
(Choose one)
If you are an instructor, what do you teach:
(Choose any that apply)
PREFERRED MAILING ADDRESS
(if a second line is needed for this address, enter in Street 2 below)
Your answer
PREFERRED MAILING ADDRESS (continued) STREET 2
Your answer
CITY
Your answer
State
Required
ZIP
Your answer
PHONE (Cell)
Your answer
PHONE (Work)
Your answer
SHALL WE SIGN YOU UP FOR THE TSI-PD PROGRAM LISTSERV?
PROFESSIONAL DEVELOPMENT:
Please note the different formats available for professional development and the differences in professional development credit hours.
I am registering for the following ONLINE professional development session/s:
MM
/
DD
/
YYYY
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