Mail-in registration form

Registration Form for Courses in Schaumburg SD 54
Location: Rafferty Center, 524 E. Schaumburg Rd., Schaumburg, IL 60194
Time: 4:00 PM - 8:00 PM
Last Name
First Name (formal)
Middle Initial
Maiden Name
Home Address
Phone (home)
Zip Code
Cell Phone
Preferred Email Address
District Name
District Address
School Name
Zip Code
School Address
Zip Code
Work Phone Number
Preferred Mailing Address  Home  School/Work
Grade Level(s)
Current Position  Administrator  Bilingual Program Director  Coordinator  Counselor  Parent  Principal  School Board Member
 School Psychologist  Social Worker  Speech Therapist  Superintendent  Teacher Assistant  Teacher  Other
Current Program Type  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
Fall 2015
Assessment of Language Minority Students CIL-510 163002650
September 23, 30, October 7, 14, 21, 28, November 4, 11, 18, 25 (clinical), December 2, 2015.
Winter 2016
Reading in New Language: Linguistic Considerations CIL 512 163002680
January 6, 13, 20, 27, February 3, 10, 17, 24, March 2, 9, 16, 2016.
Pay in Full $615.00
Pay in Full $615.00
Registration deadline for Assessment class is December 18, 2015.
For payment by check ONLY, mail to: The Center/IRC, PO Box 408379, Chicago, IL 60640-0010
For payment by credit card, mail to: The Center/IRC, 2626 S Clearbrook Dr., Arlington Heights, IL 60005
□ Check #______ enclosed in the amount of $
(make check payable to THE CENTER)
□ Charge my credit card in the amount of $
□ Visa
□ Master Card
Account number
Cardholder Name (please print clearly)
Expiration date
Cardholder Email Address
Cardholder billing address:
State ____Zip Code _________County
Cardholder signature
I have read and agree to the registration and attendance terms and policies as related to courses listed on the next
page. Please Initial:_______________
CODE: 4330 40 300-16
If you have missed the deadline, you must call the IRC prior to mailing a registration form to ensure space is available.
IRC Attendance Policy
These Bilingual and ESL endorsement courses are graduate level courses with the expectation that students will attend all
classes promptly. It is highly recommended that you make every effort to attend the first class of any course sequence as
the general scope of the course/clinical dates/assignments are outlined in the syllabus distributed at this first session. In
order to avoid a conflict with regard to attending the first session, please check your school calendar before registering for a
specific course. (Conflicts due to national or religious holidays may be resolved with an instructor.) Should there be an issue
pertaining to non-attendance at any class session, it will be the student’s responsibility to obtain any missed information.
For evening classes, one absence with an acceptable excuse is permitted, but two missed 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. Should a student need to withdraw/drop a course, the request must be submitted in
Please note that in cases of bad weather, TV/radio/website announcements regarding National Louis University may not
apply to IRC classes. Please call the IRC directly for possible class cancellations. This information will also be posted on
the IRC website. Saturday class participants should contact their instructor directly.
IRC Registration and Payment Policy
Registration for the fall course must be accompanied by tuition payment in full for the amount of $615.00. Of this amount,
$75.00 is non-refundable and 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. 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.