ChemEx^2 Summer Course Registration
Please complete this form to register for the ChemEx^2 Summer course at Stanford University, June 25th – 29th , 2018.

Payment or purchase order information must be received within 7 days of registration. CSET accepts payment by personal check, school/district check, and purchase order. Your spot is not confirmed until payment is received.

Please make checks out to "Stanford University - CSET" and send them to:
Lauren Ellison
Center to Support Excellence in Teaching (CSET)
520 Galvez Mall, CERAS 536
Stanford, CA 94305

Email address *
First Name *
Your answer
Last Name *
Your answer
Phone number *
Your answer
School name *
Your answer
School address (including city, state, zip code) *
Your answer
Home address (including city, state, zip code) *
Your answer
Date of birth
The Stanford Continuing Studies office requires DOB if you wish to receive Continuing Education Units (CEUs).
Please enter your date of birth
How many years of teaching experience do you have?
Do you have dietary restrictions? *
If yes, please state your restriction(s).
Your answer
Thank you!
Never submit passwords through Google Forms.
This form was created inside of Stanford University. Report Abuse - Terms of Service - Additional Terms