School Psycholoy CPD

Course Selection

Select the class(es) you want to register for:

21110 - SCASP: Supporting Challenging Students (PSYC 670-600) March 21, 2024

21111 - SCASP: Advanced Threat Assessment (PSYC 670-601) March 22, 2024

Term

Participants are expected to pay for their course(s) by the date determined by the program director. Participants may pay securely online after submitting this form.

Participants whose course(s) are paid by a school district or outside organization may still register for the course and will be asked for their sponsorship information as a part of their registration.

Participants may enroll in one or both sections of the course if offered.

Select "Yes, my sponsor will pay for me" if you are registering yourself but your employer is making the payment separately for you.

Select "No, I will pay for myself" if you are registering and paying for yourself.

Are you being sponsored?

Yes, my sponsor will pay for me

No, I will pay for myself

Sponsor's Information

Organization Name*

Contact's First Name *

Contact's Last Name *

Contact's Email Address *

Contact's Phone Number *

Name

Prefix

First Name *

Middle Name

Last Name *

Previous Last Name if applicable

Sufix

Contact Information

Permanent Home Address *

Country

Street

City

Region

Postal Code

Email Address *

Phone Number *

Biographical Information

Gender *
This information is only used for mandatory federal and state reporting purposes which requires the use of only female/male options.

Birthdate *

Warning! Please double check your birthdate.

Birth Country *

Residency Information

Are you a permanent resident of South Carolina?

Yes

Have you been a resident for more than 1 year?

Yes

Citizenship Information

Primary Citizenship *

Are you an U.S. Permanent Resident? *

Yes

Please upload a copy of your Permanent Resident Card*

Visa Type *

Please upload a copy of your passport showing your visa*

Social Security Number (omit dashes) *

We are committed to protecting your privacy.

Upon receiving the secure transmission of your Social Security Number, it is immediately encrypted. Only the last 4 digits of your Social Security Number are available in plaintext for identification and account matching purposes. Your Social Security Number is available for decryption only by those officials who oversee the automated loading of personal information into student information systems, and only for that limited purpose.

Our databases are actively monitored and are firewalled to ensure the protection of your personal information, and employ all industry-standard safeguards.

Race/Ethnicity

Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, and newspapers, to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests, we ask you to answer the following two questions.

Are you Hispanic or Latino? *

Yes

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member: *

Academic History

List the institution where you obtained your bachelor's degree.

Institution Name *

Degree *

Date Conferred *

Are you currently enrolled in a degree seeking program at Winthrop University?

Yes

Which degree program?

Current Employer

Organization Name *

Organization Address*

Country

Street

City

Region

Postal Code

Signature

I certify that the information contained in this application is complete and accurate without evasion or misrepresentation. I understand that acceptance by the university is based on truth and accuracy of representation as contained in this application. I agree that as long as I am a student at Winthrop University, I will comply with all the regulations of the university.

Admission as a graduate non-degree student does not guarantee subsequent admission into a graduate degree program. Students classified as graduate non-degree who later elect to pursue a degree program must have all their credentials evaluated for admission to the program they wish to pursue.

In place of your signature, please type your full legal name:

School Psycholoy CPD - SCASP