CENTER FOR THE ENHANCEMENT OF TEACHING UPPER DARBY SCHOOL by ths54408

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									        CENTER FOR THE ENHANCEMENT OF TEACHING
              UPPER DARBY SCHOOL DISTRICT
             Martha Menz, Staff Development Director

                      In-Service Course Registration Form

Please complete and return with check payable to Center for the Enhancement of
Teaching. Send to Martha Menz Office, Upper Darby School District, 4611 Bond
Ave., Drexel Hill, Pa. 19026


Course Title (s): ____________________________________________________

__________________________________________________________________

__________________________________________________________________
Last Name, First Name, Middle Initial

__________________________________________________________________
Address

__________________________________________________________________
City                            State                 Zip

___________________________________
Social Security Number

__________________________________________________________________
Work Phone #                              Home Phone #

__________________________________________________________________
District/School                           Grade Level/Subject


Certification: _____ Level 1 _____ Level 2 _____ Other


Type of Credit: _____ In-Service _____ Graduate (if applicable)

								
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