Logo - CESA 11
Logo - CESA 11
CESA 11
Facilitating the Future/Visions Registration Form

2011 Facilitating the Future/Visions Registration Form:

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First Name:
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Last Name:
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District/Campus/Organization:
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Position:
Administrator   Instructor
Other
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Content Area and/or Grade Level
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School/Campus Address:
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City/State/Zip:
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School/Campus Phone:
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Main Email:
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Home Address:
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City/State/Zip:
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Home/Cell Phone:
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Home Email:
14.
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1st Choice Learning Community--All learning communities are eight days unless otherwise indicated.
 *If the learning community you plan to attend has one, two or both weeks option be sure you check the boxes indicating your choice(s).

 (1 required)
College & Career Ready   Building Bridges
Economics for Any K-14 Classroom   On Course
Learning Pathways-Wk 1 only   CISCO Essentials
Fundamentals of SolidWorks   Food Science/FCS-Wk 1 only
Food Science/FCS-Wk 2 only   Food Science/FCS-Both Wk s
*WI Comprehensive School Counseling-Wk 1/Level I   *WI Comprehensive School Counseling-Wk 1/Level III
*WI Comprehensive School Counseling-Wk 2/Level II   *WI Comprehensive School Counseling-Wk 2/Level II.5
Technology Adventures-Wk 1   Technology Adventures-Both
Engineering Is Elementary-Wk 1 only   Teaching & Learning on the Cloud-Wk 1 only
Common Core (CCSS)-Math/June 20   Common Core (CCSS)-ELAJune 23
Visions for the Future-Aaron Doering (June 21)   Visions for the Future-Jane Bozarth (June 22)
Visions for the Future-Both Days (June 21 & 22)   Professional Learning Communities Wk 2 Only
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2nd Choice Learning Community--in case 1st choice is full or cancelled.

 (1 required)
College & Career Ready   Building Bridges
Economics for Any K-14 Classroom   On Course
Learning Pathways-Wk 1 only   CISCO Essentials
Fundamentals of SolidWorks   Food Science/FCS-Wk 1 only
Food Science/FCS-Wk 2 only   Food Science/FCS-Both Wks
WI Comprehensive School Counseling-Wk 1 Level I   WI Comprehensive School Counseling-Wk 1/Level III
WI Comprehensive School Counseling-Wk 2/Level II   WI Comprehensive School Counseling-Wk 2/Level II.5
Technology Adventures-Wk 1 only   Technology Adventures Both Weeks
Engineering Is Elementary-Wk 1 only   Teaching & Learning on the Cloud-Wk 1 only
Common Core (CCSS) Math/June 20   Common Core (CCSS) ELA/June 23
Visions for the Future-Aaron Doering (June 21)   Visions for the Future-Jane Bozarth (June 22)
Visions for the Future-Both Days   Professional Learning Communities-Wk 2 only

                                       Registration Fees & Payment Method
                            WITC, CESA #11, CESA #12 & Rusk Co. Participants
16.

Early Bird Registration Fee (Before April 15th)
8 Days--$300   4 Days--$200   2 Days--$125   1 Day--$75
17.

After April 15, 2011
8 Days--$350   4 Days--$225   2 Days--$135   1 Day--$85

Out-of Region Participants
18.

Early Bird Registration Fee (Before April 15th)
8 Days--$350   4 Days--$225   2 Days--$135   1 Day--$95
19.

After April 15, 2011
8 Days--$400   4 Days--$250   2 Days--$145   1 Day--$105

Please choose one of the methods of payment below--make checks payable to CESA #11. Payment or appropriate paperwork must be received at CESA #11 within two weeks of submission of your online registration.
20.

CESA #11 District Participants if using consortium funds (must provide local designee signature on appropriate paperwork).
Carl Perkins Funds
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WITC Option
WITC Participant

Other payment options:
22.

PO #
23.

Personal or School Ck #

Cancellation Policy: $25 fee will be charged for cancellations received before June 1, 2011. No registration fees will be refunded for cancellations made after June 1, 2011.

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