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
MM
/
DD
/
YYYY
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!
Submit
Never submit passwords through Google Forms.
This form was created inside of Stanford University. Report Abuse - Terms of Service - Additional Terms