Registration Form | Professional Development Units

Please Note: A separate registration form is required for EACH Course Number.

All fields are required

Credit Card # (VISA / Mastercard / Discover / Amex)

Expiration Date

Amount to charge

Highest Degree Earned
Degree Earned From
Previously enrolled in Professional Development from UOP?YesNo
Previously enrolled in a Courses4Teachers course
Previously enrolled in a University of the Pacific course (aside from Courses4Teachers)
School District (No Abbreviation)
Office of Education or Induction program where you completed your Induction training
Year of Program 12ECOMentor
Academic Year of Program
Course Number (Only one course number may be added)
Course Title
Number of Semester Units of credit
Proof of Completion (if required) File types allowed: PDF,JPG, PNG, BMP, XLS, XLSX | Max upload: 2 MB

S.S.# (Last four only)
Phone (Home)
Phone (Work)
Birth Date *

(Month)
(Day)
(Year)

First Name
Middle Initial
Last Name
Address
City
State
ZIP
Your Email
Additional Emails (All comma separated emails where you wish to receive information)

Fee per unit: $50.00
Tuition Submitted

Notes