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IHSCDEA Cohort Interest Form
Please complete the following form to express your interest in joining an upcoming cohort.
You will need your IEIN number to complete the form. If you do not know this, you can look it up by clicking this link
IEIN Lookup
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
IEIN
*
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Illinois
Indiana
Wisconsin
Zip Code
*
Your answer
Phone Number
*
Your answer
Email
*
Your answer
School Employed at or if undergraduate, University attending
*
Your answer
Do you possess an ISBE Professional Education License (PEL) Certificate?
*
Yes
No
How did you become aware of the USF TEP program?
*
Colleagues
Website Search
A flyer
IAHPERD Convention
DuPage Conference
Other:
Preferred Cohort
*
June 2024
By checking the box to the left, I acknowledge that submission of this interest form does not confirm enrollment in a Driver Education cohort. I will be contacted by IHSCDEA to confirm participation and subsequently provided with information to formally register for the cohort courses
*
Yes
Required
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