Online Course Registration
 
Online Course, Date, Credit Hour
District Information
 
USD Number and Name *
 
Contact Person *
 
Contact's Phone *
   
Contact's Email *
Registrant's Information
 
Name *
 
Street Address *
 
City *
 
State *
 
Zip or Postal Code *
 
Home Phone *
 
Cell Phone
 
Work Phone
   
Email *
 
Grade Level *
Member Status
 
Professional Development *
 
Payment Options: *
Purchase Order #
(Make individual checks to SCKESC, due the day of enrollment.)
Notes/Questions


P.O. BOX 160. 13939 Diagonal Rd  |  Clearwater, KS 67026  |  Phone: 620-584-3300  |  Fax: 620-584-3307
© 2007 South Central Kansas Education Service Center