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UNIVERSITY OF THE PACIFIC
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REGISTRATION FORM
— Post-baccalaureate semester units of credit from University of the Pacific, Center for Professional & Continuing Education. Professional Development Courses are for graduate participants who are NOT pursuing an advanced degree at UOP. Acceptable where local districts approve and applicable to state licensing where authorized. Tuition fees are nonrefundable. UOP is fully accredited by WASC.
Please enroll me in:Number of SemesterUnits of Credit........
Fee PerUnit.....
TuitionSubmitted....
Highest Degree earned ___________ From _______________________________________________
Previously enrolled in Professional Development from UOP? YES NO District: _____________________________________________________________________
COURSE NUMBER:
P E D UCOURSE TITLE:
AREA CODE & PHONE NUMBER
HM:
WK:
FOR ADMINISTRATION USE ONLY
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NAME
ADDRESS
HomeE-mailAddress
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—CITY
©CECG Inc. Rev 6/01
Cost per semester unit $93
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Instructions for Completing the Registration Form
To Email Registration Form: (Our Email Site is Secure)- Download the blank PDF Registration Form shown above to your desktop.- Reopen the saved registration form on your desktop. Type in all requested information.- Send the completed registration form via email, as an attachment, to [email protected] Please put in the subject line, “New Registration”- Upon receiving your email with completed Registration Form, you will receive a “Thank you and con�rmation” email within 2
business days.- If you do not receive your con�rmation email, please notify us.
To Print and Mail Your Registration Form:- Complete the form and click the button on the form above.- From the “Print Size” options, please select “Actual Size” and then print. (Do not select “�t to page” as the entries will not line up
in the form.)- Mail the printed Registration Form to: Courses4Teachers LLC, University of the Paci�c Attn: Karin Alexander 696 San Ramon Valley Boulevard, #518 Danville, CA 94526