Outreach Services · Continuing Education
University of Wisconsin-Stout · School of Education
Registration Form

* = Required
Social Security Number *
(If you are non-U.S. citizen, enter 'Non-US'. You will be assigned an identification number).


Tuition Fee: http://www.uwstout.edu/soe/profdev/register.shtml

Term:
Spring Semester
Summer Session
Fall Semester

Payment Options     MO/YR
University Billing www.uwstout.edu/soe/profdev/register.shtml
Mastercard Card Number Exp. Date
VISA Card Number Exp. Date

The University of Wisconsin-Stout requests this information for the purpose of enrollment. No persons outside the university are routinely provided this information, except for items of directory information such as name and local address. Released information is governed by Board of Regents rules and applicable state and federal statutes. Responses to items marked "optional" are optional; RESPONSES TO ALL OTHER ITEMS ARE REQUIRED. If you fail to provide the required information, the university may refuse to enroll you in the course.

1. Date Today:   

2. Name
Last Name:
First Name:
Middle Name:
Maiden Name:
If previously enrolled at University of Wisconsin-Stout or elsewhere under any other name, list that name (Last, First, Middle):


3. Home Address or Present Mailing Address:

Street:   City:   
State:   Zip Code:   
Country:   WI County:   
Home Phone:   Work Phone:   
Cell Phone:   Home Email *:   
  Work Email:   
Wisconsin Resident: Yes No
4. Gender: Male Female Transgender

5. Birth Date (mm/dd/yyyy):

6. Marital Status: Married Single


7. Citizenship:
Citizen
Non-resident Alien
Permanent Immigrant

Alien Registration Number:
Country of Citizenship:
Place of Birth (if not U.S.):
  
City:
State:
Country:


8. For what courses(s) are you enrolling?
Course Selection

Select the appropriate course. For dates and course descriptions, visit the workshop homepage by clicking on the workshop URL.

 EDUC v SPRING 696B 930 Integrating Social Media Instructional Strategies February 6 - March 2, 2012
  1 graduate credit http://www.uwstout.edu/soe/profdev/social-media-instructional-strategies.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SPRING 696C 931 Using Games for Learning and Assessment April 9 - May 4, 2012
  1 graduate credit http://www.uwstout.edu/soe/profdev/games-for-learning-and-assessment.cfm
 CLICK FOR DESCRIPTION
 
 RDGED V SPRING 702 930 Reading in the Content Areas K-12 February 13 - April 27, 2012
  3 graduate credits (can be applied to reading certification WI 316) http://www.uwstout.edu/soe/profdev/rdgcontent.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SPRING 744 909 Middle School Through Adult 6-Traits Writing Instruction February 6 - March 30, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/traits.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SPRING 744 914 Methods of Teaching Middle School Math (Grades 4-8) February 13 - April 6, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/middlemath.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SPRING 744 920 PK-Elementary 6-Traits Writing Instruction February 6 - March 30, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/traits.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SPRING 744 971 Integration of Science, Technology, Engineering and Math (STEM) February 6 - April 6, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/integration-of-stem.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SPRING 760 932 E-learning for Educators February 6 - March 30, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/elearning.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SPRING 762 931 Assessment in E-learning March 5 - May 4, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/assessonlineclass.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SPRING 765 931 Trends and Issues in Instructional Design April 30 - June 22, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/idtrends.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SPRING 766 930 Instructional Strategies and Assessment Methods February 27 - April 20, 2012
  3 graduate credits (Note Prerequisite EDUC 765; This is the second course for the Instructional Design Certificate program. http://www.uwstout.edu/soe/profdev/idstrategies.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SPRING 767 932 Designing Computer-Based Training April 30 - June 22, 2012
  3 graduate credits (Note Prerequisite EDUC 766; This is the third course for the Instructional Design Certificate program.) http://www.uwstout.edu/soe/profdev/cbt.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SPRING 768 930 Project Management for Instructional Development February 27 - April 20, 2012
  3 graduate credits (Note Prerequisite EDUC 767; This is the last course for the Instructional Design Certificate program.) http://www.uwstout.edu/soe/profdev/idprojmanagement.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SUMMER 640 960 Poverty in Schools June 25 - August 3, 2012
  2 graduate credits http://www.uwstout.edu/soe/profdev/poverty.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SUMMER 641 960 Mobile Learning Instructional Design June 18 - August 17, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/mobilelearning.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SUMMER 642 960 Teaching Digital Media Literacy in the Content Areas: Using Primary Sources June 18 - July 27, 2012
  2 graduate credits http://www.uwstout.edu/soe/profdev/primarysources.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SUMMER 643 960 Differentiated Instruction - Meeting the Needs of Diverse Learners June 11 - August 3, 2012
  3 graduate hours http://www.uwstout.edu/soe/profdev/differentiation.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SUMMER 696C 960 Using Games for Learning and Assessment July 9 – August 3, 2012
  1 graduate credit http://www.uwstout.edu/soe/profdev/games-for-learning-and-assessment.cfm
 CLICK FOR DESCRIPTION
 
 RDGED v SUMMER 701 960 Developmental Reading K-12 June 4 - August 17, 2012
  3 graduate credits (can be applied to reading certification WI 316) http://www.uwstout.edu/soe/profdev/devreading.cfm
 CLICK FOR DESCRIPTION
 
 RDGED v SUMMER 703 960 Childrens Literature in the Reading Program (grades K-5) June 11 – August 17, 2012
  3 graduate credits (can be applied to reading certification WI 316) http://www.uwstout.edu/soe/profdev/childrenslit.cfm
 CLICK FOR DESCRIPTION
 
 RDGED v SUMMER 704 960 Young Adult Literature in the Reading Program (grades 6-12) June 11 – August 17, 2012
  3 graduate credits (can be applied to reading certification WI 316) http://www.uwstout.edu/soe/profdev/yalit.cfm
 CLICK FOR DESCRIPTION
 
 RDGED v SUMMER 705 960 Instructional Techniques For Assisting Students with Reading Difficulties June 4 - August 17, 2012
  3 graduate credits (can be applied to reading certification WI 316) http://www.uwstout.edu/soe/profdev/instrtech.cfm
 CLICK FOR DESCRIPTION
 
 RDGED v SUMMER 706 960 Assessment and Evaluation of Reading and Language Development June 4 - August 17, 2012
  3 graduate credits (can be applied to reading certification WI 316) http://www.uwstout.edu/soe/profdev/rdgassess.cfm
 CLICK FOR DESCRIPTION
 
 RDGED v SUMMER 707 960 Practicum in Reading Difficulties May 19 – August 17, 2012
  3 graduate credits (Note Prerequisite RDGED 706; This is the final course for the reading certification WI 316) http://www.uwstout.edu/soe/profdev/rdgpracticum.cfm
 CLICK FOR DESCRIPTION
 
 EDUC V SUMMER 744 911 Effective Classroom Management June 11 - July 20, 2012
  2 graduate credits http://www.uwstout.edu/soe/profdev/management.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SUMMER 744 925 Bullying in Schools June 18 - July 27, 2012
  2 graduate credits http://www.uwstout.edu/soe/profdev/safeschool.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SUMMER 744 929 Web Design for Educators June 18 - August 10, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/webdesign.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SUMMER 744 966 Implementing Instructional Technology Innovations June 18 - August 17, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/innovations.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SUMMER 744 970 Strategies for Dealing with Disruptive Behavior June 18 - August 10, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/disruptive-student-behavior.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SUMMER 760 960 E-learning for Educators June 11 - August 3, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/elearning.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SUMMER 761 960 Collaborative Communities in E-learning June 18 - August 10, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/onlineclass.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SUMMER 762 960 Assessment in E-learning June 11 - August 3, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/assessonlineclass.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SUMMER 763 960 Instructional Design for E-Learning June 11 - August 3, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/instructonline.cfm
 CLICK FOR DESCRIPTION
 
 EDUC v SUMMER 764 960 E-Learning Practicum June 11 – August 3, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/elearningpracticum.cfm
 CLICK FOR DESCRIPTION
 
 EDUC w FALL 744 967 Teaching Strategies for Students with Autism October 1 - November 16, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/autism.cfm
 CLICK FOR DESCRIPTION
 
 EDUC w FALL 765 900 Trends and Issues in Instructional Design August 27 - October 19, 2012
  3 graduate credits http://www.uwstout.edu/soe/profdev/idtrends.cfm
 CLICK FOR DESCRIPTION
 
 EDUC W FALL 767 900 Designing Computer-Based Training August 27 - October 19, 2012
  3 graduate credits (Note Prerequisite EDUC 766; This is the third course for the Instructional Design Certificate program.) http://www.uwstout.edu/soe/profdev/cbt.cfm
 CLICK FOR DESCRIPTION
 



9. Graduate Credit Enrollees Only
Yes No
I have applied for admission to the graduate college at UW-Stout in the past five years.
Yes No
I have previously enrolled in a graduate course through UW-Stout.
I have been admitted to the graduate program at UW-Stout.

I no longer want to pursue the above degree.
  Note: Students seeking/changing, a degree must complete the Application for Graduate Admission/Enrollment form, which is available from the Graduate College.
Please send me the application material to apply to the graduate degree program.
I plan to take courses as a Non-Degree Special Student for transfer to simply to extend my education. This does not constitute application/admission to a degree program.


Educational History

10. From what high school did you graduate?:
High School Name:  
High School City:  
State/Province:  
When? MO/YR:  


11. Have you previously taken courses offered through UW-Stout, either on or off-campus?:
Yes No
If yes, when (MO/YR)?:     
Intended Major/Program:  
Undergraduate Graduate


12. College Record:
COLLEGE/UNIVERSITY CITY/STATE MO/YR DEGREE EXPECTED/
RECEIVED
EXAMPLE: UW-Stout Menomonie, WI 5/1981 BS/Early Childhood

13. I plan to apply credit toward:
Graduate Degree at UW-Stout
Teacher Certification
Vocational Certification
Transfer to Another College
Personal Professional Development
Other:


Please note: Students wishing to transfer credits, MUST check with their academic advisor.

14. Are you a US Veteran?
Yes No

15. (OPTIONAL) Please check which applies to you from the following selections.

The U.S. Office of Education, in compliance with the Civil Rights Act of 1964, requires institutions of higher education to compile and report enrollment data on students broken down by racial ethnic composition. This data is for statistical purposes only and will be treated confidentially.

1. American Indian or Alaskan Native
2. Asian or Pacific Islander
3. Black, Non-Hispanic
4. Hispanic/Latino
5. International Student
6. White, Non-Hispanic
7. No Selection

16. How did you hear about UW-Stout online professional development courses? (Check all that apply)
Administrator or Human Resources
Curriculum coordinator
Colleague
Email
Listserv
Advertisement/newspaper
Outreach Services-Continuing Education Web site
UW-Stout School of Education Web site
Internet search for online courses
Infobytes electronic newsletter
My degree program director/advisor
Access Stout online registration website
Other (describe)




As a result of clicking on the following button, your information will be submitted for approval. The University of Wisconsin-Stout reserves the right to restrict enrollment and to cancel courses that do not meet minimum enrollment requirements.

You will receive registration confirmation by e-mail.

University of Wisconsin-Stout
Outreach Registration
109 Bowman Hall
Menomonie, WI 54751-0790

Phone: 715-232-5167
Fax: (715) 232-2436


http://www.uwstout.edu/soe/profdev/

If you have any questions email: Online Professional Development

*Withdrawal Procedures:*

If, after submitting the enrollment form, you find that you need to drop the class before the first day of class, send a withdrawal request by email to wardda@uwstout.edu or fax: (715) 232-2436 (Telephone withdrawals cannot be accepted).

*Refunds are granted according to the following policy:
http://www.uwstout.edu/soe/profdev/register.shtml#a5