Early Start Education Certificate Program Registration Form

First Name

Middle Name

Last Name

Birthdate

Gender

Female

Male

Other

Gender Identity

Mailing Address

Country
Street
City
Region
Postal Code

Email Address

Telephone

Cell Phone

School

CEEB

Year of Graduation

Area of interest you plan to pursue in college

Please indicate which course(s) you wish to take in the upcoming semester

16 weeks (January 13, - May 7, 2020)

3 credit hour course options (choose one for this semester):

Psychology 121 (elective)

Education 201 (elective)

1 credit hour course (optional add on):

Health Education 100

Fees:

$125 per credit hour

Applicants to the program must submit an official transcript. Please send your transcripts to cal@evansville.edu or mail it to:

Attn: Center for the Advancement of Learning

University of Evansville
1800 Lincoln Ave
Evansville, IN 47722

16week 3c

16week 1c

This total will be billed to you soon; please watch your email to make payment