Colorado Association of School Executives (CASE)

49th Annual Convention

Online Registration Form for Graduate Credit

fields marked with a * are required

Name (First,Middle,Last): *      *
Current Mailing Address
Street Line 1 *
Street Line 2
Zip Code*  Phone number: (No Dashes)
Nation :
Personal Information
Email Address*
Date of Birth:  *
Gender (M/F)*

If you have taken classes at ASU previously and know your ASU ID (a 9 digit number that starts with 900), enter it here - otherwise leave this field blank.
ASU ID number:
Your SSN is used for tax purposes only and is *not* used as a personal identifier.
SSN (with no dashes):
Ethnicity Information.
Ethnicity Code:

The following Selective Service question must be answered to comply with the Colorado State Law:
If you are a male born after December 31, 1959, by checking this box you certify that you are registered with the Selective Service.

Please Select the highest degree that you have been awarded (Bachelors Degree required to take courses for Graduate Credit)
Select from the drop down list:

Please note: Registration for 1.0 credit is for full 2 day conference attendance.

Also, registration for graduate credit MUST be received by December 13, 2018 - no late registrations will be accepted.

Please Select the course(s) you would like to register for (NOTE: registration for more than one semester may be open at any given time)
Enter a string to search on to limit the number of courses listed (not case sensitive):

Convention paid attendance will be verified for approval of credit.

Statement of Certification

By selecting that you agree, you are certifying that you are the person who has completed the information furnished on all sections of this application. You are certifying that to the best of your knowledge, the information furnished is true and complete. You understand that if found to be otherwise, it is sufficient cause for delay of admission, loss of credit, rejection or dismissal. You also understand that by enrolling in courses at Adams State University you are subject to all academic policies as they relate to your enrollment including but not limited to the Academic Integrity Policy 100-03-01. For more information regarding Academic Integrity, please go to *I understand that by submitting this information via electronic transmission that I acknowledge the above in lieu of a signature*

By completing registration for this semester I am entering into a legal binding contract with Adams State University (ASU) to pay all tuition, fees and related expenses, including late fees. I accept full financial responsibility for each registered course. I authorize ASU, the Extended Studies department, and their respective agents and contractors to contact me regarding my loan, student account or any balance owed to ASU at the current or any future number either provided or acquired for my cellular phone or other wireless device using automated telephone dialing equipment or artificial or pre-recorded voice or text messages or e-mail address either provided or acquired and/or the ASU student e-mail address I am provided by the institution. Past due balances are subject to placement with a collection agency. I agree to reimburse ASU the fees of any collection agency, which may be based on a percentage of debt up to 40%, and all costs and expenses, including reasonable attorney's fees ASU may incur in such collection efforts in accordance with Colorado statutes. ASU may also certify to the Colorado Department of Revenue my name, social security number, amount of debt, and other identifying information required by the Department for collection of my debt from the tax rebate amounts owed to me, if any. C.R.S §23-5-115

To pay by credit card, please select the 'Credit Card' option and press the Submit button. If you would like to print an invoice and mail in a check or money order, select the Mail In Check or Money Order option and press the Submit button to generate a printable invoice.