Registration Form for Courses in Chicago
Location: Palmer Elem. School, 5051 Kenneth, Chicago, IL 60630
Time: 4:00 PM – 8:00 PM
❏ Mr. ❏ Ms. ❏ Mrs. Last Name
__________
First Name (formal)
_______
Maiden Name _________________________ Home Address
City
______________ County _____________________ State _________ Zip Code _____________
Phone (home)
____Cell Phone
Social Security Number (last 4 digits)
___ ____________________
Preferred Email Address _____________________________
School Name/District/Program Name
School/Work Address
City
______________ State _________ Zip Code _____________ County ____________________
Phone (work)
Position
Preferred Mailing Address: Home _________
Grade Level(s)
School / Work _________
❏ ESL ❏ Bilingual ❏ General Education ❏ Dual Language ❏ Other ________________________________________________
Please indicate whether or not you have had the following courses:
❏ Yes ❏ No
Foundations in Language Minority Education
❏ Yes ❏ No
Methods and Materials .......❏ ESL ❏ Bilingual
Note: Attendance at the first class of each course is mandatory. A student will be dropped from the class
if s/he does not attend this first session.
If you have missed the deadline, you must call the IRC prior to mailing a registration form to ensure space is available.
Please complete and mail registration with your check (payable to The Center) or credit card number to:
The Center: Resources for Teaching and Learning/Illinois Resource Center,
P.O. Box 2401,
Bedford Park, IL 60499-2401
WINTER 2011
Reading in New Language: Linguistic Considerations CIL-512 114020281
Jan. 5, 12, 19, 26, Feb. 2, 9, 16, 23, Mar. 2, 9, 16, 2011
Deposit: $75.00
_________
Balance Due: $475.00
___________
❏ Check enclosed in the amount of $_________ (make check payable to THE CENTER)
❏ Charge my credit card in the amount of $
❏ Visa: Account number
____ Expiration date
❏ Master Card: Account number
____ Expiration date
Cardholder (please print)
Cardholder signature
I have read and agree to the registration and attendance terms and policies related to IRC courses as listed on the
attached page of this document. Please Initial: _____
Code: 4330-40-300-11
Registration Deadline for IRC is 4 Weeks Prior to the Starting Date of This Course Based on
Space Availability!
If you have missed the deadline, you must call the IRC prior to mailing a registration form to
ensure space is available.
IRC Registration and Payment Policy
Registration for courses must be accompanied by a $75 nonrefundable deposit per course. Deposits
cannot be applied toward any other courses in the event of cancellation by the participant. After the
second session of the course, there will be NO tuition refunds. The remaining tuition balance (minus
deposit) must be paid no later than four weeks prior to the course starting date. If full payment has not
been received four weeks prior to the start date of the course, a student will be dropped from the class
roster in order to accommodate others who may be on the waiting list. Because of limited enrollment
policies, registration will be taken on a first come, first served basis.
The IRC reserves the right to cancel a course due to low enrollment.
IRC Attendance Policy
These are graduate level courses with the expectation the students will attend all classes promptly.
Attendance at the first class of each course is mandatory. A student will be dropped from the
class if s/he does not attend this first session.
For evening classes, one absence (half-day for all-day classes) with an acceptable excuse is permitted,
but two missed classes (one day for all day classes) will cause the student’s grade to be lowered one
letter and after a third absence the student must withdraw from the course. Significant lateness will
accumulate as an absence as well.
For further information, call the Illinois Resource Center 224-366-8555
CLASSES FILL QUICKLY – REGISTER AS SOON AS POSSIBLE.