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: Tuition Payment Options
http://www.uwstout.edu/soe/profdev/register.cfm

Term:
Spring Semester
Summer Session
Fall Semester

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 t FALL 640 900 Poverty in Schools: Working with At-Risk Students October 5 - November 13, 2015
  2 graduate credits http://www.uwstout.edu/soe/profdev/poverty.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 641 900 Mobile Learning Instructional Design (for Chromebooks, IPads, tablets, and cell phones) September 28 - December 4, 2015
  3 graduate credits http://www.uwstout.edu/soe/profdev/mobilelearning.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 642 900 Teaching Digital Media Literacy in the Content Areas: Using Primary Sources September 28 - November 13, 2015
  2 graduate credits http://www.uwstout.edu/soe/profdev/primarysources.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 645 900 School-wide Positive Behavioral Interventions and Supports (PBIS) September 28 - November 20, 2015
  3 graduate credits http://www.uwstout.edu/soe/profdev/pbis.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 646 900 Using Games for Learning and Assessment September 28 - October 23, 2015
  1 graduate credit http://www.uwstout.edu/soe/profdev/games-for-learning-and-assessment.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 647 900 Strategies for Teaching Students with Autism in the Inclusive Classroom September 28 - November 20, 2015
  3 graduate credits http://www.uwstout.edu/soe/profdev/autism.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 648 900 Math Assessment for Response to Intervention (RtI) September 28 - November 6, 2015
  2 semester hours graduate credit http://www.uwstout.edu/soe/profdev/mathrti.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 650 900 Integrating Social Media Instructional Strategies September 28 - October 23, 2015
  1 graduate credit http://www.uwstout.edu/soe/profdev/social-media-instructional-strategies.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 651 900 Project-based Learning in the Flipped Classroom November 2 - December 18, 2015
  2 graduate credits http://www.uwstout.edu/soe/profdev/flippedclassroom.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 652 900 Universal Design for Learning November 2 - December 18, 2015
  2 graduate credits http://www.uwstout.edu/soe/profdev/universal-design.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 653 900 Middle School Through Adult 6-Traits Writing Instruction September 28 - November 20, 2015
  3 graduate credits http://www.uwstout.edu/soe/profdev/traits.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 654 900 PK-Elementary 6-Traits Writing Instruction September 28 - November 20, 2015
  3 graduate credits http://www.uwstout.edu/soe/profdev/traits.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 655 900 Strategies for Dealing with Disruptive Behavior September 21 - November 13, 2015
  3 graduate credits http://www.uwstout.edu/soe/profdev/disruptive-student-behavior.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 656 900 Bullying in Schools October 5 - November 13, 2015
  2 graduate credits http://www.uwstout.edu/soe/profdev/safeschool.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 658 900 Issues in Science, Technology, Engineering and Math (STEM) Education September 21 - November 13, 2015
  3 graduate credits http://www.uwstout.edu/soe/profdev/integration-of-stem.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 659 900 Methods of Teaching Middle School Math (Grades 4-8) September 21 - November 13, 2015
  3 graduate credits http://www.uwstout.edu/soe/profdev/middlemath.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 660 900 Teaching for Creativity and Innovation: The Maker Culture September 28 - November 20, 2015
  3 graduate credits http://www.uwstout.edu/soe/profdev/maker.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 664 900 Mindful Approaches to Classroom Management September 28 - December 4, 2015
  3 graduate credits http://www.uwstout.edu/soe/profdev/management.cfm
 CLICK FOR DESCRIPTION
 
 RDGED t FALL 702 900 Reading in the Content Areas K-12 September 28 - December 11, 2015
  3 graduate credits (can be applied to reading teacher certification WI 316) http://www.uwstout.edu/soe/profdev/rdgcontent.cfm
 CLICK FOR DESCRIPTION
 
 RDGED t FALL 703 900 Children's Literature in the Reading Program September 14 - November 27, 2015
  3 graduate credits (can be applied to reading teacher certification WI 316) http://www.uwstout.edu/soe/profdev/childrenslit.cfm
 CLICK FOR DESCRIPTION
 
 RDGED t FALL 704 900 Young Adult Literature in the Reading Program (grades 6-12) September 14 - November 27, 2015
  3 graduate credits (can be applied to reading teacher certification WI 316) http://www.uwstout.edu/soe/profdev/yalit.cfm
 CLICK FOR DESCRIPTION
 
 RDGED t FALL 705 900 Instructional Techniques For Assisting Students with Reading Difficulties September 21 - December 4, 2015
  3 graduate credits (can be applied to reading teacher certification WI 316) http://www.uwstout.edu/soe/profdev/instrtech.cfm
 CLICK FOR DESCRIPTION
 
 RDGED t FALL 720 900 Leading and Directing the Reading Program September 21 - December 4, 2015
  3 graduate credits (can be applied to reading specialist certification WI 17) http://www.uwstout.edu/soe/profdev/leadreading.cfm
 CLICK FOR DESCRIPTION
 
 RDGED t FALL 721 900 Supporting Literacy Instruction September 28 - December 11, 2015
  3 graduate credits (can be applied to reading specialist certification WI 17) http://www.uwstout.edu/soe/profdev/lteracy-instruction.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 760 901 E-learning for Educators October 12 - December 11, 2015
  3 graduate credits http://www.uwstout.edu/soe/profdev/elearning.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 761 900 Collaborative Communities in E-learning - Online Facilitation Skills October 19 - December 18, 2015
  3 graduate credits http://www.uwstout.edu/soe/profdev/onlineclass.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 762 900 Assessment in E-learning October 19 - December 18, 2015
  3 graduate credits http://www.uwstout.edu/soe/profdev/assessonlineclass.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 762 901 Assessment in E-learning September 14 - November 6, 2015
  3 graduate credits http://www.uwstout.edu/soe/profdev/assessonlineclass.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t FALL 766 900 Instructional Strategies and Assessment Methods October 19 - December 18, 2015
  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 t FALL 768 900 Project Management for Instructional Development October 19 - December 18, 2015
  3 graduate credits (Note Prerequisite EDUC 765, EDUC 766, and EDUC 767; This is the fourth and last course for the Instructional Design Certificate program. http://www.uwstout.edu/soe/profdev/idprojmanagement.cfm
 CLICK FOR DESCRIPTION
 
 RDGED t SPRING 701 930 Developmental Reading K-12 January 19 - April 1, 2016
  3 graduate credits (can be applied to reading teacher certification WI 316) http://www.uwstout.edu/soe/profdev/devreading.cfm
 CLICK FOR DESCRIPTION
 
 RDGED t SPRING 706 930 Assessment and Evaluation of Reading and Language Development January 25 - April 15, 2016
  3 graduate credits (can be applied to reading certification WI 316) http://www.uwstout.edu/soe/profdev/rdgassess.cfm
 CLICK FOR DESCRIPTION
 
 RDGED t SPRING 707 930 Practicum in Reading Difficulties January 11 - April 15, 2016
  3 graduate credits (Note Prerequisite RDGED 706; This is the final course for the reading teacher certification WI 316) http://www.uwstout.edu/soe/profdev/rdgpracticum.cfm
 CLICK FOR DESCRIPTION
 
 RDGED t SPRING 722 930 Reading Specialist Field Experience January 11 - May 6, 2016
  3 graduate credits (NOTE Prerequisites: completion of RDGED 720 and RDGED 721 and instructor approval) http://www.uwstout.edu/soe/profdev/readingsp-field-experience.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t SPRING 745 930 Assessment for Learning - Progress Monitoring January 19 - May 6, 2016
  3 graduate credits http://www.uwstout.edu/soe/profdev/data.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t SPRING 760 930 E-learning for Educators January 4 - February 26, 2016
  3 graduate credits http://www.uwstout.edu/soe/profdev/elearning.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t SPRING 763 930 Instructional Design for E-Learning January 4 - February 26, 2016
  3 graduate credits http://www.uwstout.edu/soe/profdev/instructonline.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t SPRING 764 930 E-Learning Practicum January 4 - April 22, 2016
  3 graduate credits http://www.uwstout.edu/soe/profdev/elearnpracticum.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t SPRING 765 930 Trends and Issues in Instructional Design January 4 - February 26, 2016
  3 graduate credits http://www.uwstout.edu/soe/profdev/idtrends.cfm
 CLICK FOR DESCRIPTION
 
 EDUC t SPRING 767 930 Designing Computer-Based Training (CBT) January 4 - February 26, 2016
  3 graduate credits (Note Prerequisite EDUC 765 aand 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