Workshop Registration Form

Please fill out the following form to be considered.

Last Name	First Name	Email Address

Campus (Use the drop down arrow to select a location)

Department (ENG, MATH, ED, etc.)

Phone (last four digits if university extension)

Workshop (Use the drop drown arrow to select a workshop)

Workshop Date (Use the drop drown arrow to select a month/date)

Month Date Year

Status

Faculty Staff Student Other (specify)

Comments (Special needs? Use only Macintosh? Learning Expectations?)