 University
of Wisconsin-Stout Professional
Development Program Enrollment Form
Complete three tests within a 12-month period and earn a Professional Development
certificate. Each test examines knowledge gained from two issues of Early Childhood
News and is worth one continuing education unit (CEU). A minimum of 80% accuracy is
necessary to earn a CEU. You may begin the program at any time during the year. Check
which issue you'd like to begin with:
| Register by: |
Read articles
in: |
Take the test
in: |
Exams due by: |
| _____ Oct. 1, 1999 |
Aug/Sep; Oct. 1999 |
Oct. 1999 issue |
Dec 1, 1999 |
| Enrollment Options and Cost: |
You have two options, both of which include a $23.95 one-year subscription to Early
Childhood News. (If you already subscribe, we'll extend your subscription for one
additional year.) Check the option that works best for you. NOTE: If one or more
associates join with you in the program, there is a savings of $10.00 each.
| _____ I wish to enroll for three CEUs,
which entitles me to earn a Professional Development Certificate. My cost
is $89, or $79 each for two or more to enroll. |
| _____ I wish to enroll for one CEU,
which entitles me to earn one Continuing Education Unit. My cost is $59,
or $49 each for two or more to enroll. |
(All orders must be prepaid.)
____ Check enclosed in the amount of $__________
payable to Early Childhood News.
|
____ Charge to (circle one):
Master Card Visa
Discover American Express
Card # _________________________________ Exp. Date ______________Signature ______________________________________________________ |
| Center/ School Information: |
Center/School ________________________________
Address ____________________________________
City, State, Zip _______________________________
Phone ______________________________________ |
(and mailing addresses if different from above)
Please print names as you wish them to appear on certificates.
Name: ______________________________________
Address: ____________________________________
___________________________________________Name:
______________________________________
Address: ____________________________________
___________________________________________
Name: ______________________________________
Address: ____________________________________
___________________________________________ |
| Mail this form with payment to: |
ECN/CEU
P.O. Box 49579
330 Progress Rd.
Dayton, OH 45449 |
|