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Summer
Non-Profit Org.
US POSTAGE
2011
PAID
Everyone is a learner Northampton,
MA
Course Catalog
Permit No. 47
Teach. Collaborative for Educational Services
Educator Licensure Programs
97 Hawley Street
Northampton, MA 01060
RETURN SERVICE REQUESTED
Become a
licensed educator
Convenient
Renew your
educator license Hybrid-Online and
Earn an
Traditional Classes
additional license
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
Practical.
Affordable.
Quick. Statewide
SUMMER
2011
Program can
be completed in
12-18 months
PDPs, graduate credit, Master’s Degree and CAGS options available.
NEWS Meet Our Instructors
CES educational resources Matthew Beyranevand is a mathematics teacher and professional development
presenter for the Lowell Public Schools.
inform and enhance our programs
Carol Bradley is principal of the Berlin (MA) Memorial School, and has served
When you participate in the CES Educator Licensure
as a teacher , assistant principal, curriculum specialist in Massachusetts and
Program, you join a community of educators engaged in
New Jersey.
a constellation of exciting projects, dealing with the real
challenges and learning opportunities we face in today’s Nancy Cheevers is a National Board Certified English/Language Arts teacher
classrooms, schools, and communities. in the Northampton Public Schools.
Damon Douglas is a former classroom teacher who now serves as Coordinator
Using Primary Sources
of Special Projects in Learning and Leadership at the Collaborative.
This summer, we share the resources of our colleagues
in the Collaborative’s Emerging America project to offer Les Edinson is a Support Facilitator for the Pioneer Valley District and School
an exciting new course, Using Primary Sources, as part Assistance Center. He is a retired principal with experience in both urban and
of the History, Humanities, and English Initial licensure rural environments.
program, which began with this year’s spring semester. Carol Gregory has served as an administrator and teacher in Massachusetts
Since 2006, Emerging America has introduced hundreds and recently retired as assistant superintendent in the Wellesley Public Schools.
of Western Massachusetts teachers to in-depth work Martha Harrington retired from a career as a special education teacher and
with primary sources through the successful Teaching consultant in the Brookline Public Schools.
American History program. In 2010, the Library of
Congress awarded a grant to the Collaborative to Patricia Hogan-Cerasuolo teaches history and other social studies, including
serve as one of 27 Teaching with Primary Sources AP Psychology, at Minnechaug High School. She previously taught in Holyoke.
(TPS) Consortium members nationwide, providing Rick Last is a Curriculum Implementation and Professional Development
professional development throughout Massachusetts Consultant for the Collaborative.
in the use of the Library’s vast online resources. Visit
EmergingAmerica.org or learn more about Teaching Mary Morgan is a grant coordinator and Title I teacher for the Wareham Public
with Primary Sources at www.loc.gov/teachers/tps. Schools.
Jennifer Rickard is a Lead Elementary Special Education teacher for the
Authors and expertise add depth Shrewsbury Public Schools.
Our English as a Second Language program benefits
Richard Seelig is a retired math and science teacher, who has taught in
from our affiliation with colleagues in the Collaborative’s
public schools in Springfield, Northfield, and Watertown, as well as Madison,
Center for English Language Education (cele.
Wisconsin.
collaborative.org). Instructor and staff member Ken
Pransky’s book, My Fantastic Words Book, is the newest Liz Skelley is a special education teacher at Smith Vocational and Agricultural
addition to our literacy resources, joining Director School and a winner of the Grinspoon Excellence in Teaching Award.
Debbie Zacarian’s recent book Teaching English Sue Smith is a recently retired Facilitator/District Support Specialist for the
Language Learners and her upcoming Transforming Lowell Public Schools.
Schools for English Learners.
Jennifer Traverso is the Title I Director and a Reading Specialist for the Shirley
Other CES contributors and colleagues, from Damon
Public Schools. She has also served as a consultant to Massachusetts DESE.
Douglas’ and Liz Skelley’s Collaborative Teaching Model
to Sandy Roth’s Literacy Partnership, add both currency Nick Young is Superintendent of the Hadley Public Schools. He has previously
and depth to the teaching in our Licensure programs. served as a teacher, counselor/psychologist, principal, and district level director.
A $50 late fee will be applied for all registrations received after 5:00pm on the date noted in each course description.
A maximum class size will be set for each course. Registrations will be 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 collaborative.org and at teachinmass.org. You may also
INFORMATION
call 413.586.4900 after 6:30am for information about morning
classes, and after 12:00pm for afternoon class information.
2
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:
TeachInMass.org
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 TeachInMass.org or contact us at:
413.586.4900 or 800.278.4244
E-Mail: licensure@collaborative.org
Affordable. Practical. Statewide.
Educator Licensure Programs Information Sessions
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
FIRST FRIDAYS IN NORTHAMPTON (4-5pm)
413.586.2878 fax
e-mail: licensure@collaborative.org Regular information sessions are held on the First Friday of every month
TeachInMass.org 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: April 1, May 6, June 10*, July 8* , August 5, September 9*,
districts, communities, and students October 7, November 4, December 2 (*denotes second Friday)
with diverse learning needs since 1974.
School district information sessions may be scheduled on request.
Everyone is a learner
3
COURSE OPTIONS The affordable, practical route to an Initial License.
Any licensure course may be taken either as part The Collaborative for Educational Services Initial License as a teacher or school
of a Licensure Program or as an individual course. is a respected leader in professional administrator that is both intellectually
Courses may be taken for: development for PreK-12 educators, exciting and grounded in experience.
with over thirty years of experience in Courses are offered throughout the year.
• Professional Development Points (PDPs)
meeting the specific needs of teachers, Each license preparation program
• Graduate Credit (additional cost) administrators, and school districts. The consists of six courses and a practicum.
• Master’s Degree or CAGS from Fitchburg State distinctive insights we have gained through Many people complete these programs
University (additional required courses and cost) this work have guided us in developing in eighteen months while continuing to
innovative, high quality license preparation work full time, although enrollees may
programs that are designed by educators, take up to five years to complete the
for educators. The knowledgeable program. Through our higher education
COURSE LOCATIONS professionals who teach our courses are partner, Fitchburg State University,
experienced in their fields and understand licensure candidates may also elect to
the challenges facing teachers today— receive graduate credit or complete an
because they share them.
*Holyoke MEd or CAGS. Those already working
Our licensure programs provide a quick, in schools have the opportunity to
Kittredge Center, Holyoke Community College
practical, and cost-effective route to an integrate their practicum into their work.
303 Homestead Avenue, Holyoke, MA 01040
Lowell
C.W. Morey Elementary School
130 Pine Street, Lowell, MA 01851
*Northampton Earn your Master’s in Education or Certificate of
Collaborative for Educational Services Advance Graduate Study (CAGS) through Fitchburg
97 Hawley Street, Northampton, MA 01060 State University (formerly Fitchburg State College)
Worcester
Quinsigamond Elementary School
14 Blackstone River Road, Worcester, MA 01607
Directions are available at: TeachInMass.org
*While we endeavor to meet students’ site For graduate program In collaboration with Fitchburg State University
preferences, we reserve the right to move courses application procedures and (FSU), licensure courses at all of our locations across
between locations in the Pioneer Valley area to more information, contact: Massachusetts can also be taken for graduate credit.
accommodate enrollment needs.
Beverly Streeter • FSU graduate credits are available for each
HEC Licensure Programs CES Licensure Program course for an additional fee;
413-586-4900 x145 current cost for 3 credits (subject to change) is $255
bstreeter@collaborative.org • Registration for graduate credit and payment to
FSU occurs at the first session of every course
At Fitchburg State University: Graduate credits earned through Collaborative
Stephen Hemman Licensure Program courses may be used toward a
Program Coordinator Master’s Degree (MEd in Curriculum & Teaching)
978-821-2890 or, for those who already have a Master’s Degree, a
shemman@fsc.edu Certificate of Advanced Graduate Study (CAGS) from
Fitchburg State University.
Kathy McCoy
Graduate & Continuing Ed. A typical plan of study for the MEd includes:
Admissions Counselor • Collaborative courses required for licensure (18 credits)
978-665-3136 • A 3-credit seminar taken in conjunction with the
kmccoy@fsc.edu practicum
• 15 additional credits
TO EARN A GRADUATE In conjunction with Fitchburg State University, the
DEGREE YOU MUST Collaborative prepares Educational Leaders who are
SUBMIT A PROGRAM KNOWLEDGEABLE, ETHICAL, SKILLFUL,
APPLICATION TO FSU. and CARING.
EARLY ENROLLMENT
IS ENCOURAGED.
GRADUATE CREDIT
4
Summer 2011
All courses in our Educational
Administration program are available
statewide in hybrid-online format,
offering increased flexibility and access.
Bureaucracy in Education
This course focuses on how participants have experienced school—as students, as teachers, and
as leaders—and how the organization of schools and districts creates those experiences. The rules
under which schools operate, the intention of the educational reforms and movements that underlie
those rules, and the interaction between those rules and individual goals are examined. The course Level: K-12
requires writing similar to that required in schools and districts as well as writing that draws on 67.5 PDPs | 3 Graduate Credits
students’ experiences with schools. Participants will gain an understanding of some of the areas Course required for Licensure Program
of rule setting within an organization including, but not limited to, collective bargaining, state and
federal regulations, broad expectations regarding education reform, and school district budgets. Instructors: Carol Bradley, Carol Gregory
Course Format: Hybrid Online Course Format: Traditional Classes Register by: June 7, 2011
3 in-person sessions (Sat, 9:30am-12:30pm): Tue-Fri (8:00am-1:00pm): Jun 28, 29, 30, Jul 1 ($50 late fee applies after this date)
Jun 25, Jul 23, Aug 20 (Course ends Aug 23); and Jul 5, 6, 7, 8 (Course ends Jul 22)
WORCESTER HOLYOKE
Curriculum Leadership and Evaluation
This course is designed for administrators who must become knowledgeable about curriculum
development and program evaluation. The role of the administrator as a decision-maker and as
an instructional leader is explored. Emphasis is placed on program development and evaluation,
Level: K-12 | 67.5 PDPs | 3 Graduate Credits
which reflects the various cultural and ethnic minority groups that children and youth represent.
Course required for Licensure Program
Additionally, practical applications of programs, as well as the application of evaluation models and
techniques, are investigated. A field-based experience is a requirement of this course.
Instructors: Damon Douglas, Les Edinson
Course Format: Hybrid Online Course Format: Traditional Classes
3 in-person sessions (Sat, 9:30am-12:30pm): Mon-Thu (8:00am-1:00pm): Jul 11, 12, 13, 14 Register by: June 23, 2011
Jul 9, Aug 6, Aug 27 (Course ends Aug 30); and Jul 18, 19, 20, 21 (Course ends Aug 5) ($50 late fee applies after this date)
WORCESTER HOLYOKE
Contemporary Issues in Education
This core course is designed to encourage students to think about the history and foundations of
educational practice and issues. Students will reflect upon past, current, and emerging educational
practices and issues using a variety of frameworks: historical, theoretical, social, political and legal.
Current issues discussed will include teaching as a profession. Particular emphasis will be placed Level: K-12 | 67.5 PDPs | 3 Graduate Credits
on rethinking personal assumptions, considering alternative perspectives, and investigating current Course required for Master’s Program Only
and emerging educational theories, practices and issues.
Course Format: Hybrid Online Instructor: Nick Young
3 in-person sessions (Sat, 9:30am-12:30pm): Register by: May 25, 2011
Jun 11, Jul 9, Jul 30 (Course ends July 30); ($50 late fee applies after this date)
NORTHAMPTON
Working with Individuals with Special Needs
The needs, levels of functioning, and contributions of individuals with special needs are examined.
Educational issues and strategies for understanding and working with individuals with autism,
communication, developmental delay, emotional, health impairment, intellectual, multiple Level: K-12 | 67.5 PDPs | 3 Graduate Credits
disabilities, neurological impairment, physical, sensory, specific learning, and traumatic brain
Course required for Licensure Program
injury are explored.
Course Format: Hybrid Online Course Format: Traditional Classes Instructors:
3 in-person sessions (Sat, 1:00-4:00pm): Mon-Thu (2:00-7:00pm): Jul 11, 12, 13, 14 Martha Harrington, Liz Skelley, Susan Smith
Jul 9, Aug 6, Aug 27 (Course ends Aug 30); and Jul 18, 19, 20, 21 (Course ends Aug 5)
WORCESTER NORTHAMPTON, WORCESTER, LOWELL Register by: June 23, 2011
($50 late fee applies after this date)
5
Summer 2011 All coursework is due by the course end date.
Working with the Range of Students in Mathematics
This course focuses on teaching mathematics to diverse student groups, including, but not limited to,
those with special needs, targeting the “big ideas” of mathematics in order to help students develop a
strong sense of understanding what is behind the numbers. Participants observe, analyze, and define
children’s mathematical learning needs utilizing a variety of evaluative techniques, both informal Level: K-12 | 67.5 PDPs | 3 Graduate Credits
and formal, and to identify the essential knowledge, understandings and skills embodied in a diverse Course required for Licensure Program
mathematical curriculum. The data obtained through the assessment process assists in the planning
and implementation of plans for learning including, but not limited to, Individualized Education
Instructors: Matthew Beyranevand,
Plans (IEPs). The evaluation of learning styles (both self and student) is central to this process
Rick Last, Jennifer Rickard
and is investigated along with a variety of techniques that can be incorporated into instruction of
mathematics. Related current research is examined. Explicit relationships with the Massachusetts Register by: June 7, 2011
Curriculum Frameworks are explored within the context of each discipline. Using this common set of ($50 late fee applies after this date)
goals, participants create grade level specific lessons and activities.
Course Format: Hybrid Online Course Format: Traditional Classes
3 in-person sessions (Sat, 9:30am-12:30pm): Tue-Fri (2:00-7:00pm): Jun 28, 29, 30, Jul 1 and
Jun 25, Jul 23, Aug 20 (Course ends Sep 27); Jul 5, 6, 7, 8 (Course ends Sep 27)
WORCESTER NORTHAMPTON, WORCESTER, LOWELL
Inquiry Science
This course focuses on learning science through inquiry. Specifically, it considers how teachers
can help students acquire knowledge of the material world through direct investigation. It will
acquaint teachers with the process of scientific inquiry described in the Massachusetts Curriculum
Level: K-12 | 67.5 PDPs | 3 Graduate Credits
Frameworks and with standards-based approaches to science education. Rather than survey the
Course required for Licensure Program
wide range of topics that can provide subject matter for high school and middle school science,
participants will pursue a deeper understanding of specific topics through their own investigations.
Ways to facilitate student explorations of these topics will also be considered. Participants will Instructor: Richard Seelig
evaluate published curriculum materials in light of the Massachusetts Curriculum Frameworks and
Register by: June 7, 2011
reflect on the varied approaches to subject matter taken by other teachers. Strategies for assessment
($50 late fee applies after this date)
and evaluation will be introduced. Participants will be expected to complete readings, written
assignments, observations of natural phenomena, visits to middle school or high school science
classes, and a curriculum project.
Course Format: Hybrid Online
3 in-person sessions (Sat, 9:30am-2:00pm):
Jun 25, Jul 30, Aug 20 (Course ends Sep 26);
WORCESTER
Curriculum & Assessment for Teachers
This course is designed so that teachers will become knowledgeable about the theory and practice
of standards-based curriculum and assessment. It explores the teacher’s role in designing instruction
that helps all children achieve to high standards. Participants become familiar with the Massachusetts
Curriculum Frameworks, focusing particularly on student work that reflects proficiency in those Level: K-12 | 67.5 PDPs | 3 Graduate Credits
standards. Using a backward design model, teachers develop units of study that enable all students Course required for Licensure Program
to reach clearly defined academic targets. Teachers who complete this course successfully approach
teaching with an expectation that they will ultimately be leaders in the field of curriculum. Instructors:
Matthew Beyranevand, Les Edinson
Course Format: Hybrid Online Course Format: Traditional Classes
3 in-person sessions (Sat, 1:00-4:00pm): Mon-Thu (8:00am-1:00pm): Jul 11, 12, 13, 14 Register by: June 23, 2011
Course BEGINS Jul 6 ONLINE, then meets and Jul 18, 19, 20, 21 (Course ends Jul 22) ($50 late fee applies after this date)
Jul 23, Aug 6, Aug 20 (Course ends Sep 23); NORTHAMPTON, LOWELL
WORCESTER
6
Summer 2011 Licensure Program Icons:
See Page 3 for a complete list of
programs and icons.
Using Primary Sources
The objective of this course is to introduce and assist teachers in using primary sources in their
classrooms. This course emphasizes the analytical and interpretive approach by using documents,
artwork, current events, and various levels of literature to help enhance history and English
curriculum. This methodology helps students develop critical thinking skills by analyzing the who, Level: K-12 | 67.5 PDPs | 3 Graduate Credits
what, and why of the sources used. There is a focus on how the selected works impacted society, Course required for Licensure Program
who the intended audience was, and what effects the document had in general. The Massachusetts
Curriculum Frameworks will be used as a guideline; required topics will be covered. Common Core Instructor: Patricia Hogan-Cerasuolo
Standards for Language Arts and History/Social Science will also be introduced. Teachers will be
Register by: June 7, 2011
able to develop lessons that they may use in their classrooms.
($50 late fee applies after this date)
Course Format: Hybrid Online
3 in-person sessions (Sat, 9:30am-12:30pm):
Jun 25, Jul 23, Aug 20 (Course ends Sep 26);
WORCESTER
Language Learning & Literacy
This course prepares teachers of reading with a broad understanding of approaches to the study
of language, linguistic concepts applicable to the study of English, concepts regarding language
learning, and the ability to use this knowledge in the context of classroom teaching and program
development. This course primarily focuses on the social context of language, including dialect
variations such as Black English, and how home and community experiences influence language
Level: K-12 | 67.5 PDPs | 3 Graduate Credits
learning in school. As a result of this course, students will have an understanding of how student
Course required for Licensure Program
background relates to language learning and, most importantly, how classroom teachers,
teachers of reading, and other professionals can promote language learning for all.
Course Format: Hybrid Online Course Format: Traditional Classes Instructors: Mary Morgan, Nancy Cheevers
3 in-person sessions (Sat, 1:00-4:00pm): Tue-Fri (8:00am-1:00pm): Jun 28, 29, 30, Jul 1 Register by: June 7, 2011
Jun 25, Jul 23, Aug 20 (Course ends Aug 23); and July 5, 6, 7, 8 (Course ends Jul 22) ($50 late fee applies after this date)
WORCESTER NORTHAMPTON
Specialized Reading Approaches
This course focuses on the variety of instructional reading programs utilized in many of today’s
schools. It provides participants with a theoretical framework that may be used as a basis for
understanding and contrasting the many different approaches being used to teach reading to the
general student population, readers experiencing difficulties reading, and students with learning Level: K-12 | 67.5 PDPs | 3 Graduate Credits
problems. Participants gain skill and competency in utilizing research to analyze the components Course required for Licensure Program
of each program while developing effective reading instruction programs for students with diverse
educational, cultural, and learning needs
Instructor: Jennifer Traverso
Course Format: Hybrid Online Register by: June 23, 2011
3 in-person sessions (Sat, 9:30am-12:30pm):
($50 late fee applies after this date)
Jul 9, Aug 6, Aug 27 (Course ends Sep 26);
HOLYOKE
The practicum is required for all licensure programs and is PRACTICUM “....course was enjoyable,
included in the program cost. If your payments are up to date and practical, responsive to our
you have completed at least four courses, required MTELs, and all needs, and motivated me to
of your enrollment documents, you may register for the practicum. Completed forms should be mailed to: be a better teacher.”
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: TeachInMass.org Northampton, MA 01060
7
For questions, write: practicum@collaborative.org
PLEASE PRINT Summer 2011
CLEARLY AND COURSE SELECTIONS
COMPLETE
EACH SECTION
Unless noted as ‘Hybrid Online,’ courses are
MAIL OR FAX REGISTRATION FORM TO: conducted in a traditional class meeting format.
COU R S E R EG I ST R AT I ON
Educator Licensure Programs, Attention: Ann Paquette Bureaucracy in Education
Collaborative for Educational Services Hybrid Online with 3 meetings in Worcester
97 Hawley Street, Northampton, MA 01060 Holyoke
413-586-2878 Fax
Curriculum Leadership and Evaluation
Hybrid Online with 3 meetings in Worcester
Last Name Holyoke
First Name Contemporary Issues in Education
Home Address Hybrid Online with 3 meetings in Northampton
Working with Individuals with Special Needs
City State Zip Code
Hybrid Online with 3 meetings in Worcester
Home Phone with Area Code ( ) Lowell Northampton Worcester
Cell Phone with Area Code ( ) Working with the Range of Students in Mathematics
E-mail Hybrid Online with 3 meetings in Worcester
Lowell Northampton Worcester
An e-mail address is required for all course participants.
Please visit our website (TeachInMass.org) for information about free Inquiry Science
e-mail accounts that are available through Google, Yahoo, and other providers. Hybrid Online with 3 meetings in Worcester
Curriculum & Assessment for Teachers
School or Work Name
Hybrid Online with 3 meetings in Worcester
School or Work Address Lowell Northampton
City State Zip Code Using Primary Sources
Hybrid Online with 3 meetings in Worcester
School Phone with Area Code ( )
Language Learning & Literacy
School Fax with Area Code ( )
Hybrid Online with 3 meetings in Worcester
School System Northampton
Position Grade Level Specialized Reading Approaches
Hybrid Online with 3 meetings in Holyoke
All registration materials and forms are also available at TeachInMass.org
413.586.4900
WI TH DRAWALS
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 (apaquette@collaborative.org), 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):
PAYME NT
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: $
8
TOTAL: $ Signature
