Mentor Course Registration

This registration form requests submission of all essential information for enrollment. Course selection is at the bottom of the form.

Mentor Course Registration Form

Mentor Training Registration

Biographical Information

Prefix * Mr.Mrs.Miss.Ms.Prof.Dr.Rev.

First Name *

Middle Name *

Last Name *

Gender *

Male

Female

Currently Married *

Yes

No

Prefer not to disclose

Former or Maiden Name

Street Address *

City *

Country * AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCôte d‘IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe

State * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code *

Preferred Email Address *

Phone Type * Home LandlineWork LandlineMobile

Phone Number *

Birth Date *

Racial or Ethnic Background * American Indian or Alaska NativeAsianBlack or African AmericanHispanic of any raceNative Hawaiian or other Pacific IslanderTwo or more racesWhitePrefer not to disclose

Citizenship * US CitizenNon-US Citizen, Permanent ResidentNon-US Citizen, Non-resident

Resident Number *

Social Security Number *

Member of WELS or ELS congregation? *

Yes

No

Name and Location of Congregation *

Course Choices

Choose Course * EDU5901 02 Instructional Mentoring, 1 credit, Online, Jul 22 - Aug 23, J SchaeferEDU5901 02 Instructional Mentoring, 12.5 clock hours, Online, Jul 22 - Aug 23, J SchaeferEDU5907 01 Conditions for Equitable Instruction, 1 credit, Online, Jul 1 - Aug 9, J SchaeferEDU5907 01 Conditions for Equitable Instruction, 12.5 clock hours, Online, Jul 1 - Aug 9, J SchaeferEDU5903 01 Observation and Conferencing, 1 credit, Online, Sep 23 - Nov 1, J SchaeferEDU5903 01 Observation and Conferencing, 12.5 clock hours, Online, Sep 23 - Nov 1, J SchaeferEDU5904 01 Coaching in Complex Situations, 1 credit, Online, Sep 2 - Oct 18, J SchaeferEDU5904 01 Coaching in Complex Situations, 12.5 clock hours, Online, Sep 2 - Oct 18, J SchaeferEDU5905 01 Using Data to Inform Instruction, 2 credits, Online, Oct 28 - Dec 13, J SchaeferEDU5905 01 Using Data to Inform Instruction, 25 clock hours, Online, Oct 28 - Dec 13, J Schaefer

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Course Credit Options

NTI covers the cost of training WELS instructional mentors. Graduate credit option is available; participants assume tuition/credit.

Radio Buttons *

WELS NTI Mentors - 12.5 clock hours option. No cost.

WELS NTI Mentors and eMSS participants. 1/2 the cost of a Graduate Credit(s).

For those who are not NTI Mentors.12.5 clock hours option - 1/2 the cost of a Graduate Credit(s).

For those who are not NTI Mentors. Graduate Credit option - Full cost of Graduate Credit(s).

For Current Tuition Rates

CLICK HERE

Comments

Please leave any comments below

Billing and Payment Information

• Payment in full is due on or before the first day of the course.  Please email the continuing education office at the email address below when to expect any late payment. Thank you.
• Upon receipt of your registration, we will email you course confirmation and an invoice via pdf attachment. If you do not receive your invoice within three working days, please contact us to verify that we have received your registration.

Questions?

Please contact our office at:

Office of Continuing Education and Graduate Studies
continuinged@mlc-wels.edu
507-233-9139