ETOM Online Teacher Certification (Canvas)

Summer 2021

First Name *

Last Name *

Title/Position *

Example: Professor

Department *

Example: Math

Street Address *

City *

State *

Zip Code *

E-mail *

Type carefully. This e-mail address is used: (1) for all communications; (2) to create your user account; and (3) to send your completion certificate.

Phone *

Please include your area code (XXX-XXX-XXXX).

Which cohort do you want? *

Summer 2021 (May 10 - June 20)

Institution *

Select your ETOM member institution or select "Non-Member."

Non-Member

If you selected "Non-Member" from the drop-down above, list your non-member institution, business or "N/A."

Name of Person Responsible for Payment *

Select "Me" if you will be paying for this certification - even if you will be reimbursed by another party. If you enter a name under "Other", you will need to provide their contact information in the next section (and they will receive a notification).

Other:

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