TIE Colorado Conference

Online Registration Form for Graduate Credit

Click here for more information about Distance Learning at Adams State University.

fields marked with a * are required

Name (First,Middle,Last): *      *
Current Mailing Address
Street Line 1 *
Street Line 2
City*
State*
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 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):







Reflect on and describe how you will implement the knowledge and/or skill gained in this conference. Provide example/s.

(Maximum characters: 2000)
You have characters left.


Please copy and paste this link and submit:


https://docs.google.com/a/adams.edu/forms/d/1jQiWkfKxhpA4PseGeZJer4JMf57K5dJHmm9ppUIcpBo/


Statement of Certification

By clicking on the Register Now button, 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.

I understand that by submitting this information via electronic transmission that I acknowledge the above statement of certification in lieu of a signature.

 
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.