WSWHE BOCES Model Schools Program

                                                            Workshop Registration Form   

NAME:________________________________________________________________

TITLE OF WORKSHOP(S)/  1.______________________________________________

   ONLINE COURSE(S)

                                    2.______________________________________________

SCHOOL DISTRICT:______________________________________________________

SCHOOL BUILDING & ADDRESS:
______________________________________________________________________

HOME PHONE:    __________________

SCHOOL PHONE: __________________

EMAIL ADDRESS (FOR CONFIRMATION): _____________________________________

(NOTE:  A WORKING EMAIL ADDRESS IS REQUIRED FOR ONLINE COURSES

______________________________________________________________________

BILLING INFORMATION: 

  ____ DISTRICT  _____ EETT GRANT    _____ CHECK ENCLOSED

TEACHER / ADMIN. /OTHER  (Circle One)   

GRADE LEVEL _________    CONTENT AREA _________

SUPERVISOR’S SIGNATURE    ___________________________________

(BOCES PARTICIPANTS ONLY) 

DEPT. ______________________   COSER # _______________

PLEASE FAX OR MAIL REGISTRATION TO:

David Ashdown , MODEL SCHOOLS PROGRAM

27 Gick Rd., Saratoga Springs, NY 12866

Phone: 581-3735 / Fax: 581-3725

dashdown@wswheboces.org