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Please complete all information below. (*) denotes a required field.
To register for more than one Site Seminar, you must fill out a new copy of this form for each course.
(*) First Name:
(*) Last Name:
(*) Sex: M F
Home Mailing Address: (*) Street Address: (*) City: (*) State: (*) Zip:
(*) Personal Cell or Home Phone (cell is preferred):
(*) Personal, Year-Round E-mail Address: (Important: we will send all correspondence to this address. Please double-check spelling and enter ONE address only!)
(*) Please re-enter Email Address for verification:
(*) School Name (if your school is not listed, select "NOT ON LIST"): *** NOT ON LIST *** Academy of Learning and Leadership Adventure Elementary School Agnes Y Humphrey School for Leadership Alice B. Beal Elementary School Alternative Elementary II Amana Academy Anderson School ANSER Charter School Arbor Vitae-Woodruff Elementary School Arlee Junior High Aurora Xpeditionary Learning (AXL) Baltimore Freedom Academy Bath Middle School Bonner Springs Elementary Bronx Expeditionary Learning High School (BELHS) Brooklyn School for Collaborative Studies Bryant Elementary School C. S. Porter Middle School Calli Ollin Academy Campbell Elementary Cantwell School Catawba Valley High School Capital City Public Charter School Casco Bay High School Central Alternative High School Charter School 37 Christa McAuliffe Regional Charter Public School City View Charter School Civano Community School Clairemont Elementary School Clark Middle School Cleveland Early College High School Codman Academy Charter School Cooperstown Middle School Decatur Discovery Academy Delaware Ridge Elementary Denver Venture School Doris M. Johnson School Duggan Middle School E.L. Haynes Public Charter School East Baltimore Community Charter School East End Community School East High School Edwardsville Elementary Elias Brookings School Entheos Academy EPIC Academy Evergreen Community Charter School Expeditionary Learning School for Community Leaders Expeditionary Learning School for Sustainability Explore Elementary Fitchburg Arts Academy Four Rivers Charter Public School Gaynor McCown Expeditionary Learning School (MELS) Genesee Community Charter School Grant Elementary Grass Valley Charter School Harbor Alternative High School Harbor High School Harborside Academy Health and Sciences High School Hiaki High Hickory Public Schools Humanities Preparatory Academy Illinois Valley High School Inland Seas School of Expeditionary Learning IS250 James Baldwin School: An Expeditionary Learning School John Stark Regional High School Kansas City Academy Kettle Falls Elementary School King Middle School Kurt Hahn Expeditionary Learning School LEAD Academy Lee A. Tolbert Community Academy Lighthouse Community Charter High School Lighthouse Community Charter School Lincoln Elementary Manzanita SEED Marsh Avenue Expeditionary Learning School Math and Science High School at Garinger Meadow Mountain Elementary MEI-Futures Academy MESA (Mapleton Expeditionary School for the Arts) Metropolitan Learning Center Midtown Academy Midtown Academy Mile High Middle School Monarch Academy Charter School New Song Academy Newsome Park Elementary School Niagara Charter School North Routt Community Charter School Northpoint Expeditionary Learning High School Oakhurst Elementary School Odyssey School Olathe North High School Palouse Prairie School Pauling Academy of Integrated Sciences Perrymont Middle Pikes Peak School of Expeditionary Learning Pocatello Community Charter School Polaris Charter Academy Polaris Expeditionary Learning School Pottenger Elementary School Prescott Elementary Charter for the Arts Prescott Mile High Middle School Prescott School, Dubuque Quest Realms of Inquiry Reavis Elementary School Red Bridge Elementary Red Canyon High School Renaissance Arts Academy Reuther Central High School Rimrock Expeditionary Alternative Learning Middle School - REALMS Rio Gallinas Charter School for Ecology and the Arts RISE Community School River's Edge Academy Robious Elementary School Robious Middle School Rocky Mountain School of Expeditionary Learning Rocky Point Charter School Rocky Ridge Boarding School Roots and Wings Community School Russell Byers Charter School Saint Louis School San Luis High School San Rafael Middle School Santa Fe School for the Arts and Sciences Scholars Academy School of Engineering & Manufacturing at Edison Complex School Without Walls Middle School Schoolcraft Learning Community School Scuola Vita Nuova Charter School Skyview School Southwest Baltimore Charter School Springfield Renaissance School St George School Summit School Syracuse Expeditionary Learning School Tapestry Charter High School Tapestry Charter School The Crossroads School The Harbor School The Silverton School of Expeditionary Learning Thomaston Grammar School Thompson Magnet Tolbert Preparatory Academy Toltecalli Tri-Valley School Two Rivers Community School Two Rivers Public Charter School Urban Community Leadership Academy Urban Promise Academy Validus Preparatory Academy: An Expeditionary Learning School Vallejo Charter School Valley View School Venture Academy Vergennes Union High School Vista Grande High School Washington Heights EL School Washington High School West Linn-Wilsonville Middle Schools West Platte Elementary West Platte Jr.-Sr. High White Swan High School William Smith High School Winnequah Middle School Winnona Park Elementary School Wiscasset Middle School Wood Hill Middle School Woolwich Central World of Inquiry-School #58 Young Achievers Science and Math School
NEW SCHOOL INFORMATION: (only needed if your school is NOT on the above list)
New School Name:
School Mailing Address:
School City, State, Zip:
School Phone:
(*) Your Position/Title:
(*) Grade Level(s):
(*) Content Area(s):
(*) Site Seminar (choose ONE)
Please indicate any food allergies:
Please note any special needs we should be aware of:
For your convenience, a block of rooms has been reserved at the hosting hotel or at a hotel near the Seminar site. You will receive a packet including hotel information as soon as it is available.
(*) Select one: My registration is covered by ELS contract (regular MOU slot). I am a school principal, registering for one of our Principal Slots. My registration is not covered by ELS contract: I will send the full payment upon acceptance of my application.
(*) Yes, I understand that in the event I need to cancel, I must fax or e-mail my cancellation at least three weeks prior to the start of the course. (FAX to 563-552-5825, e-mail to PD@elschools.org). The school will be billed for $250 for any no-shows or cancellations within 3 weeks of the start of the institute unless ELS can fill the slot.
