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School Divisions Professional Learning Registration Form


  • No spaces can be reserved without registration and payment.
  • Space is available on a first come, first served basis.
  • Within two business days you will receive an email confirmation with receipt of your registration request and instructions on how to pay your tuition.
PERSONAL INFORMATION
Title:
First Name:
Middle Initial:
Last Name:
Email:
Have you previously registered for a Professional Development course with Regent University? Yes   No
Highest Level of Education Completed:
Are you a U.S. citizen?  

Please fill out the following information. It is required as a matter of legal reporting requirements applicable to Regent University. It will not be taken into account in any admission or academic decision, nor in the administration of any program at the University.

Gender:  
Date of Birth:    
Ethnic Origin:

 

HOME CONTACT INFORMATION
Street Address:
City:
State:
Zip:
Country:
Phone: ()

 

EMPLOYMENT INFORMATION
School/Place of Employment:
School Division:

If not listed above, choose "Other" and enter here:
Occupation/Title:
Street Address:
City:
State:
Zip:
Country:
Work Phone: ()

 

REGISTRATION INFORMATION

Submitting this form indicates that I am agreeing to be registered for the following listed courses and that I take full financial responsibility unless a written request to withdraw is received seven days after the start date of the courses and the written request is granted by the Dean.

 

Note: Regent University reserves the right to change or cancel courses, so please call or visit our website (www.regent.edu/education) to confirm the location, date and time of your course prior to the first day of class.

Choose semester:
Choose year:
Course Number & Title:
If you are registering for an online course, please indicate whether you have taken the EDUC 500 Blackboard Online Orientation:  
Location:    
How did you hear about Regent?