course catalog online - Teach in Mass by jianghongl


									                             Fall 2011
                                                                                                                   Non-Profit Org.
                                                                                                                   US POSTAGE
                                                                               Everyone is a learner
                             Course Catalog
                                                                                                                   Permit No. 47

                                                                     Collaborative for Educational Services
                                                                     Educator Licensure Programs
                                                                     97 Hawley Street
                                                                     Northampton, MA 01060
                                                                     RETURN SERVICE REQUESTED

 Become a
 licensed educator
 Renew your
 educator license            Hybrid-Online and
 Earn an
                             Traditional Classes
 additional license

       Quick. Practical.
 Program can
 be completed
 in 12-18 months
                               Affordable. Statewide.
                                   E D U CATO R                      English as a Second Language . Reading
                                                                     Special Education . Mathematics . Math/Science
                                   LICENSURE                         General Science . Earth Science . Biology
                                   PROGRAMS                          Chemistry . Physics . School Administration

                                                                     NEW FOR 2011:
                                                                     History . English . Humanities


PDPs, graduate credit, Master’s Degree and CAGS options available.
NEWS                                                         Meet Our Instructors

Exciting new loan opportunity!                               Matthew Beyranevand is a mathematics teacher and professional development
                                                             presenter for the Lowell Public Schools.
The Collaborative for Educational Services is pleased to
announce a new partnership with UMass Five College           Nancy Cheevers is a National Board Certified English/Language Arts teacher
Federal Credit Union to provide loans to students            in the Northampton Public Schools.
enrolled in the educator licensure program across            Ayanna Cooper is an English as a Second Language Site Director for the
the Commonwealth. Financing is also available for            Boston Teacher Residency, and has taught in public schools, colleges and
those pursuing Masters Degrees and Certificates of           universities in Georgia and Massachusetts.
Advanced Graduate Study through the Collaborative’s
                                                             Martha Harrington retired from a career as a special education teacher and
higher education partner, Fitchburg State University.
                                                             consultant in the Brookline Public Schools.
The CES Continuing Education Loan at UMassFive is
a line of credit from which approved borrowers can use       Maureen Henry is a reading specialist for the Shrewsbury Public Schools, where
funds to pay for tuition, books, and other fees. Payment     she has also served as a literacy coach.
deferment is available to qualified applicants. For more
                                                             Diana Gondek has been an attorney in private practice specializing in
information, visit
                                                             educational law in the public sector in Massachusetts since 1975, and has also
                                                             served as an attorney for the Massachusetts Department of Education.
Licensure program responsive
to DESE changes                                              Carol Holzberg is Technology Coordinator for the Greenfield Public Schools,
                                                             and a nationally known writer and expert on educational computer software.
The Department of Elementary and Secondary
Education (DESE) is making two changes which are             Mary Morgan is a grant coordinator and Title I teacher for the Wareham Public
particularly relevant for teacher preparation.               Schools.

                                                             Amy Powell Faeskom is a trainer for the CES Center for English Language
One has to do with the DESE adoption of the Common
                                                             Education. She has served as a consultant and project leader at the
Core Standards. There is a Massachusetts Curriculum
                                                             Massachusetts DESE and has taught in the Boston Public Schools, in Ecuador
framework for English Language Arts and Literacy and a
                                                             and in Morocco.
Massachusetts Curriculum Framework for Mathematics
which incorporate the Common Core State Standards.           Maureen Ross Hickey has been a reading specialist in Massachusetts and
In Massachusetts, Initial licensure programs, like the       Connecticut since 1979. She is presently a literacy specialist in the Farmington
Collaborative’s program, focus on pedagogy rather than       (CT) Public Schools.
curriculum. We are ensuring that those courses that
                                                             Sanford Roth is a veteran classroom and special education teacher who is a
focus on pedagogy in particular curriculum areas meet
                                                             Curriculum Specialist at the Collaborative.
the expectations in the new curriculum frameworks.
                                                             Christine Shea is a former principal and special education administrator who is
The second change relates to evaluation of teachers and      the Data Specialist for the Lower Pioneer Valley Educational Collaborative..
administrators. DESE has received a comprehensive task
force report, and has drafted proposed guidelines for the
evaluation of teachers. The Collaborative professional
development staff as a whole and the licensure staff
and faculty have addressed the implications of these
guidelines for the work of the Collaborative and the
preparation required in our licensure programs.

We will continue to stay abreast of new developments
in teaching, as well as changes that may have a direct      A $50 late fee will be applied for all registrations received after 5:00pm
impact on teachers and teaching in Massachusetts. Our       on the date noted in each course description.
commitment is to continued excellence in all of our         A maximum class size will be set for each course. Registrations will be
educator preparation programs.                              accepted on a first-come, first-served basis, and must include payment.
                                                            If the number of registrations for a course exceeds the maximum
.                                                           seats available or is too low to be able to conduct a quality learning
                                                            experience, the Collaborative will inform you of available options.

                                                            Inclement Weather: Any delays or cancellations are posted
                                  IMPORTANT                 online at and at You may also

                                                            call 413.586.4900 after 6:30am for information about morning
                                                            classes, and after 12:00pm for afternoon class information.
                                                 Teacher of English as a Second Language (PreK-6) (5-12)

                                                 Teacher of Middle School Mathematics (5-8)

           We offer educator
                                                 Teacher of Middle School Math/Science (5-8)
       preparation programs                      Teacher of Mathematics (8-12)
         for an Initial license                  Teacher of General Science (5-8)
                                                 Teacher of Biology (5-8) (8-12)
                in these areas                   Teacher of Chemistry (5-8) (8-12)
                                                 Teacher of Earth Science (5-8) (8-12)
        Courses and requirements for             Teacher of Physics (5-8) (8-12)
           the programs represented
                                                 Teacher of Students with Moderate Disabilities (PreK-8) (5-12)
         by each icon are detailed at:
                                                 Reading Specialist (All Levels)
        All preparation programs offer
       hybrid-online course options for          Administrator (PreK-6) (5-8) (9-12): Principal/Assistant Principal
       increased flexibility and access          Administrator (All Levels): Superintendent/Assistant Superintendent
                                                 Administrator (All Levels): Supervisor/Director
                                                 Administrator (All Levels): Special Education Administrator

                                                 Teacher of Humanities (5-8)

         New for 2011                            Teacher of History (5-8) (8-12)

                                                 Teacher of English (5-8) (8-12)

                                                                For more information about our licensure
                                                                programs, visit or contact us at:
                                                                413.586.4900 or 800.278.4244

                                                 Information Sessions

                                                                                                                               Affordable. Practical. Statewide.
              Educator Licensure Programs
      Collaborative for Educational Services
                                                 Opportunities to learn more about our educator licensure programs will be
(formerly Hampshire Educational Collaborative)
                                                 scheduled at locations throughout the state during the coming months. Dates
97 Hawley Street, Northampton, MA 01060
                                                 and locations are posted on our website calendar as they are confirmed.
           413.586.4900 . 800.278.4244
                          413.586.2878 fax       FIRST FRIDAYS IN NORTHAMPTON (4-5pm)
         e-mail:     Regular information sessions are held on the First Friday of every month
                        from 4:00-5:00pm at the Collaborative main office at 97 Hawley Street,
                                                 Northampton. Bring your questions and sit down with someone to discuss
 The Collaborative for Educational Services      your options. We can help you to map out your program so you can begin
   is a public, nonprofit educational service    the path to a new career.
         agency serving schools and school       Upcoming: July 8* , August 5, September 9*, October 7, November 4,
        districts, communities, and students               December 2, 2011 (*denotes second Friday)
    with diverse learning needs since 1974.
                                                 School district information sessions may be scheduled on request.

           Everyone is a learner
 COURSE OPTIONS                                           The affordable, practical route to an Initial License.

Any licensure course may be taken either as part          The Collaborative for Educational             Initial License as a teacher or school
of a Licensure Program or as an individual course.        Services is a respected leader in             administrator that is both intellectually
Courses may be taken for:                                 professional development for PreK-            exciting and grounded in experience.
                                                          12 educators, with over thirty years of       Courses are offered throughout the year.
    • Professional Development Points (PDPs)
                                                          experience in meeting the specific needs      Each license preparation program
    • Graduate Credit (additional cost)                   of teachers, administrators, and school       consists of six courses and a practicum.
    • Master’s Degree or CAGS from Fitchburg State        districts. The distinctive insights we have   Many people complete these programs in
      University (additional required courses and cost)   gained through this work have guided          eighteen months while continuing to work
                                                          us in developing innovative, high quality     full time, although enrollees may take up
                                                          license preparation programs that are         to five years to complete the program.
                                                          designed by educators, for educators. The     Through our higher education partner,
COURSE LOCATIONS                                          knowledgeable professionals who teach         Fitchburg State University, licensure
                                                          our courses are experienced in their fields   candidates may also elect to receive
                                                          and understand the challenges facing          graduate credit or complete an MEd or
                                                          teachers today—because they share them.
*Holyoke                                                                                                CAGS. Those already working in schools
                                                          Our licensure programs provide a quick,       have the opportunity to integrate their
Kittredge Center, Holyoke Community College
                                                          practical, and cost-effective route to an     practicum into their work.
303 Homestead Avenue, Holyoke, MA 01040
C.W. Morey Elementary School
130 Pine Street, Lowell, MA 01851
                                                          Earn your Master’s in Education or Certificate of Advance
*Northampton                                              Graduate Study (CAGS) through Fitchburg State University
Collaborative for Educational Services
97 Hawley Street, Northampton, MA 01060
Worcester                                                 For graduate program
Quinsigamond Elementary School                            application procedures and
14 Blackstone River Road, Worcester, MA 01607             more information, contact:

                                                          Beverly Streeter                     In collaboration with Fitchburg State University
Directions are available at:
                                                          HEC Licensure Programs               (FSU), licensure courses at all of our locations
*While we endeavor to meet students’ site                 413-586-4900 x145                    across Massachusetts can also be taken for
 preferences, we reserve the right to move courses
                                                          graduate credit.
 between locations in the Pioneer Valley area to
                                                                                               • FSU graduate credits are available for each CES
 accommodate enrollment needs.
                                                          At Fitchburg State University:         Licensure Program course for an additional fee;
                                                          Stephen Hemman                         current cost for 3 credits (subject to change) is $255
                                                          Program Coordinator                  • Registration and payment to FSU for graduate
                                                                                                 credit occurs at the first session of every course
                                                           Graduate credits earned through Collaborative
                                                          Kathy McCoy
                                                                                               Licensure Program courses may be used toward a
                                                                                               Master’s Degree (MEd in Curriculum & Teaching)
                                                          Graduate & Continuing Ed.
                                                                                               or, for those who already have a Master’s Degree,
                                                          Admissions Counselor
                                                                                               a Certificate of Advanced Graduate Study (CAGS)
                                                                                               from Fitchburg State University.
                                                                                                A typical plan of study for the MEd includes:
                                                                                               • Collaborative courses required for licensure
                                                          To earn a graduate degree,             (18 credits)
                                                          you must submit a program            • A 3-credit seminar taken in conjunction with the
                                                          application to FSU.                    practicum
                                                          Enrollment before starting           • 15 additional credits
                                                          the second course at CES is
                                                          encouraged. Subject to FSU           In conjunction with Fitchburg State University,
                                                          approval, no more than twelve        the Collaborative prepares Educational Leaders
                                                          semester hours of FSU credit         who are KNOWLEDGEABLE, ETHICAL, SKILLFUL,
                                                          may be transferred to the            and CARING.
                                                          degree program. Credit must
                                                          have been earned within the
                                                          year prior to admission.
                                                                                                                 GRADUATE CREDIT
Fall 2011
                                                                                                        All courses in our Educational
                                     All coursework is due by the course end date.                      Administration program are available
                                                                                                        statewide in hybrid-online format,
                                                                                                        offering increased flexibility and access.

Cases and Concepts in Educational Administration
A case study approach to problems, issues, and situations encountered in school administration,
utilizing current managerial concepts and strategies leading to the exploration of alternative
solutions to leadership; and methods of dealing with them. Emphasis is on reflective thinking and
incorporation of pertinent research..                                                                   Level: K-12
                                                                                                        67.5 PDPs | 3 Graduate Credits
Course Format: Hybrid Online                                                                            Course required for Licensure Program
Starts Sept 24 | Ends Nov 12 (all work due)
3 in-person sessions (Saturdays):                                                                       Instructor: Christine Shea
Sept 24, Oct 22 in Holyoke (9:30am-12:30pm)
and Nov 12 in Worcester (1:00-4:00pm)                                                                   Register by: September 6, 2011
HOLYOKE (2 meetings)/WORCESTER (1 meeting)                                                              ($50 late fee applies after this date)

Law for the Educator
Constitutional and statutory provisions governing a public school system are examined on
local, state, and national levels. A thorough review will be made concerning the legal parameters
surrounding the local level of the educational system and federal and state guidelines generated to
                                                                                                        Level: K-12 | 67.5 PDPs | 3 Graduate Credits
meet the needs of diverse school populations in compliance with current judicial decisions and state
                                                                                                        Course required for Licensure Program
legislation. The impact of precedent-setting cases will be a major focus of this course.

Course Format: Hybrid Online                                                                            Instructors: Diana Gondek
Starts Nov 12 | Ends Jan 24 (all work due)
3 in-person sessions (Saturdays):                                                                       Register by: October 26, 2011
Nov 12, Nov 19, Dec 3 (9:30am-12:30pm)                                                                  ($50 late fee applies after this date)

Integrating Reading and Writing into the Subject Area Curriculum
The purpose of this course is to prepare teachers of math and science to have a broad understanding
of approaches to reading and writing as tools to promote and to evaluate learning in the content
areas. A second purpose is to prepare teachers to use their knowledge of reading and writing theory
                                                                                                        Level: 5-12 | 67.5 PDPs | 3 Graduate Credits
and strategies in the context of classroom teaching and program development. This course primarily
                                                                                                        Course required for Licensure Program
focuses on theory and strategies for learning content language/lexicon, reading expository texts, and
writing to learn and demonstrate intellectual growth and development as social processes.
                                                                                                        Instructors: Nancy Cheevers, Mary Morgan
Course Format: Hybrid Online                      Course Format: Traditional Classes
Starts Oct 1 | Ends Jan 14 (all work due)         Starts Oct 5 | Ends Jan 18 (all work due)             Register by: September 14, 2011
3 in-person sessions (Saturdays):                 Wednesdays (4:30-7:30pm):                             ($50 late fee applies after this date)
Oct 1, Nov 12, Jan 14 (1:00-4:00pm)               Oct 5, 12, 19, 26; Nov 2, 9, 16, 30;
WORCESTER                                         Dec 7, 14; Jan 4, 11, 18
                                                  LOWELL, NORTHAMPTON

*Introduction to Educational Technology
This course explores the value of technology integration for teaching, learning, and curriculum
development. We also examine the use of technology as a change agent in schools. Participants are
exposed to the variety of technology tools and resources (many Web-based) to strengthen instructional
strategies, deepen understanding of particular content, and make teaching materials more accessible     Level: K-12 | 67.5 PDPs | 3 Graduate Credits
to a heterogeneous population of students.                                                              Course required for Licensure Program

Course Format: Hybrid Online                     *formerly Impact                                        Instructors: Carol Holzberg, TBD
Starts Oct 1 | Ends Jan 14 (all work due)         of Technology on Education
3 in-person sessions (Saturdays):                                                                        Register by: September 14, 2011
Oct 1, Nov 12, Jan 14 (9:30am-12:30pm)                                                                   ($50 late fee applies after this date)

Fall 2011                           All coursework is due by the course end date.

Working with the Struggling Reader
This course is designed to give classroom teachers, reading specialists, and special education
professionals research-based background knowledge of the reading process. The course addresses
reading abilities and reading approaches as well as issues of motivation and engagement within all
the components of the language arts curriculum. There is a focus on helping teachers develop an              Level: K-12 | 67.5 PDPs | 3 Graduate Credits
ability to design and plan an approach to teaching that yields a comprehensive literacy program for          Course required for Licensure Program
struggling readers of all ages. Students will demonstrate competency in developing and modifying
lesson plans as well as reading instruction programs for students with diverse educational and/or
                                                                                                             Instructors: Martha Harrington, Sandy Roth
cultural needs by assessing, evaluating, designing and implementing prevention and intervention
strategies with one student that will require one to one tutoring sessions totaling a minimum of two         Register by: September 7, 2011
hours a week.                                                                                                ($50 late fee applies after this date)

Course Format: Hybrid Online                         Course Format: Traditional Classes
Starts Sept 24 | Ends Jan 7 (all work due)           Starts Sept 26 | Ends Jan 9 (all work due)
3 in-person sessions (Saturdays):                    Mondays (4:30-7:30pm):
Sept 24, Nov 5, Jan 7 (1:00-4:00pm)                  Sept 26; Oct 3, 17, 24; Nov 7, 14
WORCESTER                                            Dec 5, 12, 19; Jan 9, 23
                                                     LOWELL, NORTHAMPTON, WORCESTER

Assessment for Reading Instruction
The focus of this course is the assessment of what students identified with reading and/or writing
difficulties understand about the reading and writing processes. This information will then be
used as a basis for designing both group and individualized interventions to support these
students as they become more proficient readers and writers. Participants will evaluate students             Level: K-12 | 67.5 PDPs | 3 Graduate Credits
identified with literacy difficulties in reading, writing and oral language skills using formal and          Course required for Licensure Program
informal assessment tools, background information and observation. Information gathered will be
synthesized and interpreted to select appropriate strategies and plan effective academic programs            Instructors: Maureen Henry,
in the language arts. It is best if participants have access to students who have literacy difficulties in   Maureen Ross Hickey, Sandy Roth
order to carry out class assignments.
                                                                                                             Register by: September 6, 2011
                                                                                                             ($50 late fee applies after this date)
Course Format: Hybrid Online                         Course Format: Traditional Classes
Starts Sept 24 | Ends Jan 7 (all work due)           Starts Sept 22 | Ends Jan 19 (all work due)
3 in-person sessions (Saturdays):                    Thursdays (4:30-7:30pm):
Sept 24, Nov 5, Jan 7 (9:30am-12:30pm)               Sept 22; Oct 6, 13, 20, 27; Nov 3, 17
WORCESTER                                            Dec 1, 8, 15; Jan 5, 12, 19
                                                     LOWELL, NORTHAMPTON, WORCESTER

Internship and Reflective Analysis Seminar
This course provides Interns, Apprentices, and Teachers of Record with an opportunity to
demonstrate the skills they are learning in the District-based licensure coursework as well as
demonstrate competencies required for the Initial License as a Teacher of Students with Moderate
Disabilities or Teacher of Reading. The experience is designed to be a supportive one, with                  Level: K-12 | 67.5 PDPs | 3 Graduate Credits
Supervising Practitioners and Program Supervisors providing Interns, Apprentices, and Teachers of            Course required for Master’s Degree program only
Record with guidance and the support needed to enhance their development as teachers.
                                                                                                             Instructor: Matthew Beyranevand
Course Format: Hybrid Online
                                                                                                             Register by: September 28, 2011
Starts Oct 15 | Continues through Spring 2012 and ends May 12 (all work due)
                                                                                                             ($50 late fee applies after this date)
3 in-person sessions (Saturdays):
Oct 15, Jan 28, May 12 (9:30am-12:30pm)

Fall 2011                                                                                                   Licensure Program Icons:
                                                                                                            See Page 3 for a complete list of
                                                                                                            programs and icons.

*Theory and Practice in Fostering Literacy in a New Language
This course provides participants with an introduction to pedagogical approaches to reading
and writing instruction for both English Language Learners (ELLs) and students of foreign or
world languages; an overview of best practices to enhance literacy development within content
area curriculum; an in-depth examination of the learning needs of students for whom English is              Level: K-12 | 67.5 PDPs | 3 Graduate Credits
a second language at different stages of proficiency (including those with limited or interrupted           Course required for Licensure Program
formal schooling); an analysis of the differences between foreign and second language teaching
practices to promote literacy; and a survey of authentic and effective methods of assessing growth
                                                                                                            Instructor: Amy Powell Faeskorn
in language students’ reading and writing.
                                                                                                            Register by: September 15, 2011
Three core principles underlie the course design:
                                                                                                            ($50 late fee applies after this date)
1) Literacy is directly correlated to long-term academic achievement for ELLs and must be
   comprehensively and meaningfully developed across the curriculum.
2) Effective literacy instruction incorporates regular opportunities for students to develop
   academic vocabulary and oral language skills.
3) Teachers must be aware of and develop curricula that take into account differences in the ways
   reading and writing are taught and learned in second vs. foreign language classrooms. The
   essential question for this course is: How can we design curriculum and classroom practices
   to simultaneously develop the literacy of students learning content in a second language or of
   students learning a foreign language?

Course Format: Hybrid Online                        *formerly Teaching and Assessing Reading
Starts Oct 1 | Ends Jan 14 (all work due)            and Writing for English Language Learners
3 in-person sessions (Saturdays):
Oct 1, Nov 12, Jan 14 (9:30am-12:30pm)

*Theory and Practice of Acquiring a Second Language
This course provides participants with an introduction to the field of second language acquisition
(SLA), with a specific focus on issues that directly impact the second language classroom. Central
to the course design are three principles: 1) second language teachers need a deep understanding
of language learners and processes they use in learning languages; 2) teachers must become skilled          Level: K-12 | 67.5 PDPs | 3 Graduate Credits
in methods of inquiry that will allow them to continue to learn about their (ever changing) students,       Course required for Licensure Program
contexts, and subject matter; 3) teachers must have opportunities to apply these understandings to
the classroom.
                                                                                                             Instructor: Ayanna Cooper
 Course Format: Hybrid Online                       *formerly Principles of Second                           Register by: September 15, 2011
 Starts Oct 1 | Ends Jan 14 (all work due)           Language Acquisition                                    ($50 late fee applies after this date)
 3 in-person sessions (Saturdays):
 Oct 1, Nov 12, Jan 14 (1:00-4:00pm)

The practicum is required for all licensure programs and is              PRACTICUM
included in the program cost. If your payments are up to date and
you have completed at least four courses, required MTELs, and all
of your enrollment documents, you may register for the practicum.        Completed forms should be mailed to:
If you already possess an Initial/Professional License and are           Practicum Coordinator
seeking an additional license that requires a practicum (except          Educator Licensure Programs
Reading Specialist and Administrator licenses), the practicum            Collaborative for Educational Services
fee is $1900.                                                            97 Hawley Street
Practicum request forms are available at:                Northampton, MA 01060
For questions, write:                                                                                                     7
                                                                                          PLEASE PRINT                   Fall 2011
                                                                                          CLEARLY AND                    COURSE SELECTIONS
                                                                                          EACH SECTION

                                                                                                                        Unless noted as ‘Hybrid Online,’ courses are
                                MAIL OR FAX REGISTRATION FORM TO:                                                       conducted in a traditional class meeting format.

                                Educator Licensure Programs, Attention: Ann Paquette
                                Collaborative for Educational Services                                                  Cases and Concepts in Educational Administration
                                97 Hawley Street, Northampton, MA 01060                                                     Hybrid Online with 2 meetings in Holyoke
                                413-586-2878 Fax                                                                            and 1 meeting in Worcester
                                                                                                                        Law for the Educator
                                Last Name                                                                                   Hybrid Online with 3 meetings in Worcester
                                                                                                                        Integrating Reading and Writing into
                                First Name
                                                                                                                        the Subject Area Curriculum
                                Home Address                                                                                 Hybrid Online with 3 meetings in Worcester
                                                                                                                             Lowell       Northampton
                                City                                      State           Zip Code
                                                                                                                        Introduction to Educational Technology
                                Home Phone with Area Code (                    )
                                                                                                                             Hybrid Online with 3 meetings in Northampton
                                Cell Phone with Area Code         (            )                                             Hybrid Online with 3 meetings in Worcester
                                E-mail                                                                                  Working with the Struggling Reader
                                An e-mail address is required for all course participants.                                  Hybrid Online with 3 meetings in Worcester
                                Please visit our website ( for information about free                       Lowell       Northampton         Worcester
                                e-mail accounts that are available through Google, Yahoo, and other providers.          Assessment for Reading Instruction
                                                                                                                            Hybrid Online with 3 meetings in Worcester
                                School or Work Name                                                                         Lowell       Northampton         Worcester
                                School or Work Address                                                                  Internship and Reflective Analysis Seminar
                                City                                      State           Zip Code                           Hybrid Online with 3 meetings in Worcester

                                School Phone with Area Code (                      )                                    Theory and Practice in Fostering Literacy
                                                                                                                        in a New Language
                                School Fax with Area Code (                )                                                 Hybrid Online with 3 meetings in Worcester
                                School System                                                                           Theory and Practice of Acquiring
                                                                                                                        a Second Language
                                Position                                               Grade Level
                                                                                                                            Hybrid Online with 3 meetings in Worcester
                                All registration materials and forms are also available at


                                WITHDRAWAL POLICY (applies to all registrants)
                                If it becomes necessary to withdraw from a course, you must notify the Collaborative’s Licensure Programs office in
                                writing, attention Ann Paquette. Written withdrawals forwarded via mail to the address below, by fax (413-586-2878)
                                or by e-mail (, are accepted without penalty until 3:00pm, five calendar days prior to the
                                first meeting date. After that date there will be no refunds or billing adjustments.
                                I have read and I understand the above policy.

                                Signed                                                                                          Date

                                PAYMENT FOR INDIVIDUAL COURSES AND ANY                Form of Payment (individual course registrations and any late fees):

                                LATE FEES MUST BE INCLUDED WITH REGISTRATION              Check enclosed (Payable to Collaborative for Educational Services)
                                (Program enrollees are billed separately for tuition)     PO #
                                                                                                          Credit Card (ALL INFO below required):   Visa   MasterCard   Discover
                                Participation Level:
                                                                                                     Card Number
                                       Licensure Program Enrollee
                                                                                                     Expiration Date                                  V Code
                                       (Tuition payment plan per Commitment Letter)
                                                                                                     Name on Card
                                       Individual Course Registration
                                                                                                     Billing Address for Card
                                        $620 per course
                                       $50 late fee enclosed for each late course registration
                                                                                                     Total Amount to Bill to Card: $
                                  TOTAL: $                                                           Signature

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