Early Start Education Certificate Program Registration Form

First Name

Middle Name

Last Name

Birthdate

Social Security Number (required for academic record)

Legal Sex

Pronouns

Other Pronouns

Gender Identity

Gender Identity Other

Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, and newspapers, to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests, we ask you to answer the following two questions.

Please select one or more of the following to describe yourself:

Do you consider yourself to be Hispanic or Latino?

Yes

No

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

Are currently or have previously taken any courses offered through the Early Start Education Certificate Program?

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

16-week courses run August 24, 2022 - December 15, 2022

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

Psychology 226: Child and Adolescent Psychology (3 credits)

1 credit hour course (optional add on):

Health Education 100: Concepts of Health and Wellness

Fees:

$50 per credit hour plus book fees if applicable

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

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

The University of Evansville is committed to fostering an atmosphere free from harassment and discrimination. This commitment includes identifying problems that may lead to sexual harassment and misconduct, as well as other forms of harassment and discrimination, by creating an atmosphere in which the entire University community is sensitive to preventing prohibited conduct. If you feel like you have experienced sexual harassment or misconduct, or other forms of harassment and discrimination, please reach out to the University Of Evansville’s Institutional Equity and Title IX Coordinator, Annie Sills.
Annie Sills, Assistant Director of Institutional Equity and Title IX Coordinator
Center for Diversity, Equity and Inclusion, RUC 263
812-488-5261
812-455-7606
Cs175@evansville.edu
TitleIX@evansville.edu