Project Based Learning Course Sequence Registration Form

Term

Select the classes you want to register for:

30368 - Intro to Project Based Learning (EDUC 521-600) May 15 - June 2

30369 - Applications of PBL in C&I (EDUC 522-600) June 5 - June 23

30370 - Practicum in PBL (EDUC 523-600) June 26 - July 7

Term

Name

Prefix

First Name *

Preferred Name

Middle Name

Last Name *

Previous Last Name(s)

Sufix

Contact Information

Permanent 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! Double check your birthday.

Birth Country *

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 at Winthrop University?*

Yes

Have you previously attended Winthrop University?*

Yes

Previous name in records:

Teaching Information

Name of school where you currently work:

School District:

County:

Teaching Certificate/License Number*

Please upload your South Carolina Teaching Certificate*

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: