REAL 694H – Project CRISS (Warren Township)

Spring 2013

Please fill out the form below, then hit the submit button. (* denotes a required field).

Social Security Number: (999-99-9999) *

First Name: *

Last Name: *

Birthdate: (MM/DD/YYYY) *

Gender? *
Male
Female

Address: *

Address-2

City: *

State: *

Zip: *

Email Address: *

Please enter the name of the school and district in which you are employed (if your not currently working in a school enter N/A) *


Do you have a master’s degree in education?
Yes No

Are you a certified teacher?
YesNo

Are you a U.S. Citizen?
Yes No

Permanent Resident?
Yes No


Ethnic Origin

Caucasian/ White (1)
African-American/Black (2)
Hispanic or Latino (3)
Cuban (3C)
Puerto Rican (3P)
Mexican (3M)
Hawaiian or Pacific Islander (4P)
Asian (4)
Not Available (NA)
Non Resident Alien (NR)
American Indian or Alaska Native (5)
Student Declines (SD)
Other



Student Application Agreement (please read all information below)

Your application information will be received after you read and agree to the below information. You will receive a confirmation email every Friday. Please keep that email and print this page before you hit the submit for your records.

NOTE: Registration into this course is based on a minimum enrollment number. Should this class be cancelled you will be notified by USF within one week of the scheduled course start date.

Logging into your student account

If you are a new student to USF you will receive a user ID and password from the university within five (5) business days. Once you receive that information you must log-in to the university portal to access course information, billing information, etc. [NOTE: New students are those individuals who have never been enrolled in the University of St. Francis and have never had a USF User ID or password.]

If you are a returning student to USF you already have log-in information. To update or reset your user ID and password contact the Network Support Services office at (815)740-3432. [NOTE: Returning students are those individuals who have been enrolled in the University of St. Francis previously.] It is the responsibility of the student to log-in to the USF portal within five (5) business days of registering.

If you are a new student and do not receive log-in information after five (5) days please contact the Network Support Services office (815)740-3432. Once you have logged in to the USF Portal, and after five (5) days, if your course does not appear please contact the REAL office at (815)740-3699.

Additional Information

You will receive messages from REAL through your student account periodically between registration and the course start date. Please be sure to also check the SPAM folder in your personal/work email as some network security systems prevent messages from the University of St. Francis. You will also receive a welcome message within 10 days of the start date of your class that will include textbook information, instructor name, contact information and room information.

Note for Online Courses:

There will be a $100 online course fee for a 3 credit hour course, and a $125 online course fee for a 4 credit hour course added to your tuition.


 
I certify that I have entered all required fields, read the Student Application Agreement, and agree to the log-in instructions in order to complete the application process. Please proceed with the registration process using the information I submitted for this course.

Enter your Initials: *


 

 

If you have any issues with this form, please contact Ann Bell at abell@stfrancis.edu