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Registration for Supervision of Student Teachers
UNDERGRADUATE
GRADUATE
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Note: This registration form is only Supervision of Student Teachers.
 
Registration for Supervision of Student Teachers
*Last Name:
Middle Initial:
*First Name:
*Address Street:
*City:
State:
ZIP:
Home Phone:
Work Phone:
E-Mail:
Date of Birth:
Employer:
Ethnicity Information:
Are you Hispanic or Latino? Yes No
Select one or more of the following:

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

Course Registration:

[description]

Term of enrollment:
Year of enrollment:
Tuition:

With the submission of this registration, I understand that I am legally obligated to pay all tuition and fees. In the event of default, the college may refer my account to a credit reporting agency, a collection agency, and/or initiate legal action to recover any outstanding debt. I understand I am also responsible for the costs of collection including, without limitation, interest penalties, collection agency fees, court costs and attorney fees. In the event you will need to drop a course, refer to the Graduate Catalog for refund policy.

I agree

 
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