Registration Form All fields are required VISA / Mastercard / Discover / Amex Number Expiration Date 010203040506070809101112 20202021202220232024202520262027202820292030 Amount to charge Highest Degree Earned Degree Earned From Previously enrolled in Professional Development from UOP? YesNo Previously enrolled in a Courses4Teachers course YesNo Previously enrolled in a University of the Pacific course (aside from Courses4Teachers) YesNo School District (No Abbreviation) Consortium, if applicable Proof of Completion, if required (File types allowed : pdf,jpg,png,bmp.doc,docx,xls,xlsx) Year of Program 12ECO Academic Year of Program Course Number (Only one course number may be added) Course Title Number of Semester Units of credit S.S.# (Last four only) Phone (Home) Phone (Work) Birth Date (Month) Select010203040506070809101112 (Day) Select01020304050607080910111213141516171819202122232425262728293031 (Year) Select195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009 First Name Middle Initial Last Name Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Your Email Additional Emails (All comma separated emails where you wish to receive information) Fee per unit : $50.00 Tuition Submitted Notes Click here to Reload the form to register for another course
