New Teacher Center Mentor Professional Development Registration
Costs: For each two day workshop, the cost for an individual is $415 and includes meals and materials; the cost per person for a team of three or more (also including meals and materials) is $365. All payments must be made via check or purchase orders and should be made payable to Virginia Commonwealth University, FIN#54-6001758. Payment must be received at least two weeks prior to the workshop session in order to hold your confirmation. Our address is: VCU Center for Teacher Leadership; 3600 W Broad Street; Suite 300; Richmond, VA 23230

Registration: Please fill out all required information and print this form for your records BEFORE YOU CLICK THE SUBMIT button. If you are registering as an individual, please use this first page to register. If you are attending as a team, please scroll down to page 2. (Please note that one person must register for the entire team and will need email addresses for all team members.) If your team is larger than three members, please email a list of all participants including name of participant, email address, and the role each plays (example: teacher, building administrator, full-time mentor, etc.) to jtusing@vcu.edu.

Should you need to cancel, please do so at least three weeks before the applicable training session in order to receive a refund. You will know your registration is confirmed when you receive the following message: "Your information has been entered in my spreadsheet."

Last Name
Your answer
First name
Your answer
Name you prefer on your workshop nametag
Your answer
Organization
Your answer
Email Address
Your answer
Cell Phone Number
In case of emergency
Your answer
Choose only one:
If registering as an individual, please choose the position(s) that best describe your role.
Check all that apply.
Required
Please select the workshop sessions you will be attending:
All workshops will be held at VCU Center for Teacher Leadership at 3600 West Broad Street, Suite 300, Richmond, Virginia. NOTE: This is a series of workshops; only Instructional Mentoring is available as a standalone. All other workshops are sequential and require all previous workshops as prerequisites.
Required
Group Registration (If you have already registered as an individual and are ready to submit your registration, please print a copy and then scroll to the bottom of the page.)
Instructional Mentoring
This section is only for registering a team of up to three members. If you would like to register more than 3 team members, please contact us at jtusing@vcu.edu.
Attendee #1 Last Name
Your answer
Attendee #1 First Name
Your answer
Attendee #1 Email
Your answer
Attendee #1 Role
Your answer
Attendee #2 Last Name
Your answer
Attendee #2 First Name
Your answer
Attendee #2 Email
Your answer
Attendee #2 Role
Your answer
Attendee #3 Last Name
Your answer
Attendee #3 First Name
Your answer
Attendee #3 Email
Your answer
Attendee #3 Role
Your answer
Observing and Conferencing
Attendee # 1 Last Name
Your answer
Attendee # 1 First Name
Your answer
Attendee #1 Email
Your answer
Attendee #1 Role
Your answer
Attendee #2 Last Name
Your answer
Attendee #2 First Name
Your answer
Attendee #2 Email
Your answer
Attendee #2 Role
Your answer
Attendee #3 Last Name
Your answer
Attendee #3 First Name
Your answer
Attendee #3 Email
Your answer
Attendee #3 Role
Your answer
Designing Effective Instruction and Setting Professional Goals
Attendee #1 Last Name
Your answer
Attendee #1 First Name
Your answer
Attendee #1 Email
Your answer
Attendee #1 Role
Your answer
Attendee #2 Last Name
Your answer
Attendee #2 First Name
Your answer
Attendee #2 Email
Your answer
Attendee #2 Role
Your answer
Attendee #3 Last Name
Your answer
Attendee #3 First Name
Your answer
Attendee #3 Email
Your answer
Attendee #3 Role
Your answer
Using Data to Inform Instruction
Attendee #1 Last Name
Your answer
Attendee #1 First Name
Your answer
Attendee #1 Email
Your answer
Attendee #1 Role
Your answer
Attendee #2 Last Name
Your answer
Attendee #2 First Name
Your answer
Attendee #2 Email
Your answer
Attendee #2 Role
Your answer
Attendee #3 Last Name
Your answer
Attendee #3 First Name
Your answer
Attendee #3 Email
Your answer
Attendee #3 Role
Your answer
Thank you!
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms
Google Forms