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

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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 * Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d‘Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Northern Mariana Islands Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe

State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code *

Preferred Email Address *

Phone Type * Home Landline Work Landline Mobile

Phone Number *

Birth Date *

Racial or Ethnic Background * American Indian or Alaska Native Asian Black or African American Hispanic of any race Native Hawaiian or other Pacific Islander Two or more races White Prefer not to disclose

Citizenship * US Citizen Non-US Citizen, Permanent Resident Non-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 * EDU5906 01 Designing Effective Instruction, 1 credit, Online, Feb 19 - Apr 8, J Schaefer EDU5906 01 Designing Effective Instruction, 12.5 clock hours, Online, Feb 19 - Apr 8, J Schaefer EDU5901 01 Instructional Mentoring, 1 credit, Online, Jun 10 - Jul 19, J Schaefer EDU5901 01 Instructional Mentoring, 12.5 clock hours, Online, Jun 10 - Jul 19, J Schaefer EDU5901 02 Instructional Mentoring, 1 credit, Online, Jul 22 - Aug 23, J Schaefer EDU5901 02 Instructional Mentoring, 12.5 clock hours, Online, Jul 22 - Aug 23, J Schaefer EDU5907 01 Conditions for Equitable Instruction, 1 credit, Online, Jul 1 - Aug 9, J Schaefer EDU5907 01 Conditions for Equitable Instruction, 12.5 clock hours, Online, Jul 1 - Aug 9, 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