Registration Form Advanced Certificate
NOTE: Official transcripts from the post-secondary institution which granted your Bachelor of Education degree must be submitted to the Registrar’s Office prior to the third week of the first course for which you register. Registrar’s Office, Box 6004, Moncton, NB, E1C 9L7, ATTN: Marybeth Clements.
Personal Information Name
Date of Birth:
Have you ever attended Crandall? If so, what year(s)?
Background Information Current Level of Certification:
Current School District:
Degrees completed/Universities attended:
List all courses for which you are registering: Course Number (i.e. ED6706A)
Course Title Start Date (mm/dd/yyyy)
Financial Information Please be advised that I hereby authorize Crandall University to charge the $150.00 enrolment deposit to my Visa or Mastercard as I instruct them below for the student named on this form. By signing this form it will have the same force as if I have signed the Visa/Mastercard slip myself. Name of Cardholder (please print):
*a receipt will be mailed to the address listed above
Please check the appropriate boxes: Enrolment deposits ($150.00 per course listed above; non-refundable) Course tuition ($1,520.00 per 6 credit hour course; $760.00 per 3 credit hour course; subject to change as of July 1; due at course start date) Total amount to be charged: $ Cardholder Signature:
This form can be faxed to (506) 858-9694 or mailed to: Crandall University, P.O. Box 6004, Moncton, NB E1C 9L7, ATTENTION: Marybeth Clements, Assistant Registrar for Professional Studies or Kimberley Cook, Program Administrator for the Professional Studies Division. For more information dial (506)858-8970 or email firstname.lastname@example.org or email@example.com.
formerly known as Atlantic Baptist University