Name ________________________________________________________________________
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E-mail Address: __________________________________________________________ |
Address _______________________________________________________________________
City ____________________________________________ ZIP_______________
Day telephone __________________ Evening telephone ______________________
Teaching position:
School ____________________________________________ District ________________________________
Grade/Subject(s) _________________________________________________
Prior computing experience (describe):
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Do you have (or have easy access to) a computer
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Do you use any of the following with your students?
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________________________________________________________________________________
________________________________________________________________________________
Are some things that you particularly would like to get out of
this course?
Describe:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Are you interested in completing the Computer Certificate Program?
If so, please complete the following:
Course Completed in (semester)
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