Salutation Mr. Mrs. Ms. Dr. Prof.

First Name

Last Name

Email

Phone

Billing Address One

Billing Address Two

Billing City

Billing State

Billing Zip Code

Billing Country

Institution

Job Title

Which most closely describes your role within your organization? Administrator (e.g. President, Provost) Faculty Leader (e.g. Dean, Dept. Chair, Director of Center for Teaching/Learning) Faculty Member Other

In which course would you like to enroll? Creating an Inclusive and Supportive Learning Environment Creating an Inclusive and Supportive Online Learning Environment Promoting Active Learning Promoting Active Learning Online Inspiring Inquiry and Preparing Lifelong Learners Inspiring Inquiry and Lifelong Learning in Your Online Course Designing Learner-Centered and Equitable Courses Fostering a Culture of Belonging

Which date would you like to begin? May 31, 2025 August 2, 2025 October 4, 2025 January 24, 2026

Which date would you like to begin? June 7, 2025 August 9, 2025 October 11, 2025 January 31, 2026

Which date would you like to begin? March 29, 2025 May 31, 2025 August 2, 2025 October 4, 2025

Will you be teaching at the time of the course? Yes No

How will you be paying your enrollment fee? My institution will pay for my enrollment. I will use personal funds.

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