CTLW 2017Registration Form

CTLW 2017Registration Form

Please print two copies of this registration form,one for your records and one to mail in
with your $95 registration fee to:
Connecticut Department of Labor - CTLW
ATTN: Debra Barr, Office of Research
200 Folly Brook Blvd.
Wethersfield, CT 06109

Checks should be made payable to Connecticut Learns and Works.

Name:

School/Organization/Company:

Business Address:

Billing Address, if different:

Check Purchase Order* Transfer Invoice(CORE-CT) DOL Employee

If you are using a purchase order please enter it here:

*Please note that registrationspaid via purchase order will not be accepted without a purchase order number being provided at the time of registration.

All checks for individuals must be received with registrations prior to event date. Spots will not be held without payment.

Is this registration part of a group (i.e., DOL, BRS, school) or individual registration?

Individual Group

Pick four workshop titles thatyou are most interested in attending, one from each session. All workshops will runfor 50 minutes.

“Go Baby Go” will be ongoing for the entire day in the Rocky Hill Room.(YOU ALREADY TOOK CARE OF THE ADDITION INFO HERE – THANKS)

CEU’s

Effective July 1, 2012, continuing education units (CEUs) will not be required for applicants requesting continuation of the professional educator certificate. Section 36 of P.A. 12-116 eliminates the requirement for professional educator certificate holders to complete 9.0 CEUs (90 contact hours) during the five-year period for which the professional educator certificate was issued. Anyone applying on and after July 1, 2012, for a continuation of the professional educator certificate will no longer be required to provide verification of completion of CEUs. Form ED 179 Application for Continuation of Professional Educator Certificatehas been revised to reflect this change.