Professional Development in Education

SSN

Please enter your SSN without any hyphens or spaces.

Have you taken a College of Charleston Professional Development course before?

YesNo

I want to register for this term:

CWID (OPDE office only)

Personal Data

Last Name

Middle Initial

First Name

Previous/Maiden Name

Email

Street/Apartment

City

State

Zip

County of Residence

Home Telephone

Business Phone

Statistical Information

Date of Birth (MM/DD/YYYY)

Gender

FemaleMale

Citizen

US CitizenPermanent ResidentOther Visa

Are you Hispanic/Latino?

YesNo

What is your race?

Residency

Are you a current resident of South Carolina?

YesNo

SC Driver's License or ID Card Number

Year license or ID was FIRST OBTAINED

Teaching Certificate

A copy of your teaching certificate should have been turned in on the first day of class.

Certificate Number

Teaching Certificate Valid From (mm/yy)

Teaching Certificate Valid to

Name as it appears on your Teaching Certificate

Registration Acknowledgement

I hereby certify that the information I have provided is accurate and that I am completing this application in good faith. I understand that misrepresentation of facts will be viewed by the Office of Professional Development - College of Charleston as justification for revoking a registration or cancelling a registration.

Full Name

Date (MM/DD/YYYY)